A lady has delivered 20 minutes back in your hospital. Suddenly her attendant informs that she has started bleeding per vaginally. What is the first thing that a nurse would do?

Question

Question

This question was previously asked in

KGMU Nursing Officer 2023 Memory-Based Previous Year Paper

Answer 1

Correct Answer: Massage her Uterus

Rationale:

Postpartum hemorrhage (PPH) is excessive bleeding after childbirth, and it is a leading cause of maternal morbidity and mortality. In most cases, uterine atony (failure of the uterus to contract effectively) is the primary cause of PPH.
Massaging the uterus is the first and most immediate action to manage bleeding caused by uterine atony. The massage stimulates uterine contractions, which helps to compress the blood vessels at the placental site and reduce bleeding.
This technique involves applying firm, circular pressure on the lower abdomen (fundus) to encourage the uterus to contract and become firm. A soft or "boggy" uterus is a sign of uterine atony, and massage helps to restore its tone.

Explanation of Other Options:

Give her oxygen

Rationale: While oxygen therapy is important in cases of severe blood loss to improve tissue oxygenation, it does not address the root cause of postpartum hemorrhage, which is most commonly uterine atony. Thus, it is not the first action in this scenario.

Start IV fluids

Rationale: Starting IV fluids is crucial for maintaining circulatory volume and preventing hypovolemic shock due to blood loss. However, this is a supportive measure and should follow initial actions like uterine massage to address the bleeding source directly.

Give her blood transfusion

Rationale: Blood transfusion is essential in cases of severe blood loss to replace lost red blood cells and maintain oxygen-carrying capacity. However, it is not an immediate first step and is typically reserved for cases where bleeding persists despite initial measures.

Additional Information:

Postpartum hemorrhage requires a systematic approach to management, starting with identifying the cause (e.g., uterine atony, retained placenta, trauma, or coagulopathy).
After uterine massage, other interventions include administering uterotonic drugs like oxytocin, ergotamines, or misoprostol to enhance uterine contractions.
If bleeding persists, surgical interventions such as uterine tamponade, uterine artery ligation, or, in extreme cases, hysterectomy may be required.
Nurses play a critical role in early recognition and management of PPH, ensuring timely intervention to prevent complications.

Conclusion:

Massaging the uterus is the most immediate and effective first step in managing postpartum hemorrhage caused by uterine atony. It directly addresses the root cause by stimulating uterine contractions, which reduces bleeding. Other measures like oxygen therapy, IV fluids, and blood transfusion are supportive interventions that follow once the initial bleeding is controlled.