In the third stage of labor, the uterus became soft & boggy. The immediate action of nurse is?

AIIMS Rishikesh & Jodhpur NO - 2017

Obstetrics & Gynaecology

Easy

Appeared in: AIIMS Rishikesh & Jodhpur NO - 2017

Explanation

A soft, boggy uterus after delivery is a classic sign of uterine atony, the failure of the uterus to contract properly.
Uterine atony is the most frequent cause of postpartum hemorrhage (PPH), a life-threatening condition.
The immediate, first-line nursing intervention is to perform vigorous fundal massage to mechanically stimulate the uterine muscles to contract.
This contraction compresses the blood vessels at the placental site, thereby controlling the bleeding.

Option B: While fluid replacement is important for managing hypovolemia from blood loss, it is not the immediate priority. The primary goal is to stop the source of the bleeding.
Option C: Recording temperature does not address the urgent, life-threatening problem of uterine atony and potential hemorrhage. It is a routine assessment, not a priority intervention in this emergency.
Option D: Shifting an unstable patient with a high risk of massive hemorrhage to the ward is dangerous. The patient must be stabilized in the labor and delivery unit where emergency resources are immediately available.

Clinical Relevance

Nursing practice connection: Knowing Management of Uterine Atony and Postpartum Hemorrhage helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Prompt recognition and management of uterine atony are critical nursing skills to prevent maternal morbidity and mortality from PPH, a leading cause of maternal death worldwide.
Nurses are often the first to identify a boggy uterus and must initiate fundal massage immediately as a life-saving first response, often while simultaneously calling for help.
What if? If the uterus remains boggy despite vigorous massage, the nurse's next immediate actions would be to call for help (if not already done), notify the provider, ensure patent IV access, and prepare to administer uterotonic medications like oxytocin, methylergonovine, or carboprost as ordered.

How to Approach the Question

First, identify the clinical scenario: a patient in the third stage of labor, immediately postpartum.
Recognize the critical finding: a 'soft & boggy' uterus. This is an abnormal and dangerous sign indicating uterine atony and a high risk of hemorrhage.
Analyze the question's core requirement: 'immediate action'. This asks for the highest priority, life-saving intervention.
Evaluate each option based on this priority. Does the action directly address the cause of the potential hemorrhage?
Uterine massage directly stimulates uterine contraction to stop the bleeding. The other options are secondary (fluids), non-urgent (temperature), or unsafe (shifting to ward).
Select the option that provides the most immediate and effective solution to the identified life-threatening problem.

Concept Tested & Keywords

Concept Tested: Management of Uterine Atony and Postpartum Hemorrhage
Stem keywords: third stage of labor, soft & boggy uterus, immediate action
Lead-in keywords: immediate action
Clinical cues: A 'soft & boggy' uterus is a critical sign of uterine atony, signaling a high risk for postpartum hemorrhage.

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E6 Obstetrics Williams p. 49-70

E6 Comprehensive Textbook of Community Health Nursing for BSc Nursing Students Part 2 — Subpart A (pp 1-275 of 550) p. 222-224