A multiparous patient is bleeding 2 hours after vaginal delivery. What action should the nurse implement next?

• A. Determine the firmness of the fundus.
• B. Give oxytocin (Pitocin) intravenously.
• C. Inform the healthcare provider of the bleeding.
• D. Assess the vital signs for indicators of shock.

Answer: (A)

Assessing fundal tone is the first crucial step because the most common cause of early postpartum bleeding is uterine atony, which shows up as a soft, boggy uterus that isn’t contracting well. By quickly determining how firm the fundus is and where it is located, you identify whether the next move should be a fundal massage to encourage contraction and probable administration of a uterotonic like oxytocin. If the fundus is firm and midline, ongoing bleeding points to other sources (such as lacerations or retained tissue) and requires a different focus plus continued monitoring for signs of shock. The uterus’s tone essentially directs immediate management, making the firmness assessment the logical next action.