In the postpartum period, what assessment finding indicates uterine atony requiring intervention?

• A. A boggy uterus that is high in the abdomen with heavy lochia
• B. A firm uterus at the midline
• C. Fundus firm and midline
• D. Heavy lochia with a firm uterus

Answer: (A)

Uterine atony occurs when the uterus fails to contract after delivery, so the placental site doesn’t get adequately compressed and bleeding continues. The key sign is a boggy, soft fundus that is not contracting well. If that uterus is high in the abdomen, it indicates poor tone and lack of effective contraction, and heavy lochia confirms ongoing postpartum bleeding from that placental site. This combination—soft (boggy) uterus plus a high fundal position and heavy lochia—points to atony and signals the need for prompt intervention such as fundal massage, uterotonic medications, and assessing for contributing factors.

Normal tone would be a firm uterus that’s midline; that’s not consistent with atony. A heavy lochia with a firm uterus could indicate a source of bleeding other than uterine atony (such as lacerations or hematoma), so it doesn’t reflect the need for uterine contraction support.