Which observation would indicate a need to monitor for potential hemorrhage due to uterine atony related to bladder distension?

Which observation would indicate a need to monitor for potential hemorrhage due to uterine atony related to bladder distension?

• A. Boggy uterus with heavy lochia
• B. Firm uterus with scant lochia
• C. Uterus displaced and deviated fundus
• D. No lochia discharge

Answer: (A)

Postpartum, the uterus should stay firm and midline, contracting to compress blood vessels and minimize bleeding. When the bladder is distended, it can push up against the uterus and impede its ability to contract, leading to uterine atony. The best sign that hemorrhage risk is present from this atony is a boggy, soft uterus paired with heavy lochia. A soft uterus indicates poor tone and inability to compress bleeding vessels, while heavy lochia shows ongoing significant bleeding rather than the small, expected amount of lochia after delivery. Other signs—such as a firm uterus with scant lochia (indicating good contraction and minimal bleeding), a uterus displaced and deviated fundus (which can suggest bladder distension but not directly the atony causing hemorrhage), or no lochia discharge (which is not typical postpartum and could indicate other issues)—do not point as clearly to atony-driven hemorrhage due to bladder distension.

Postpartum, the uterus should stay firm and midline, contracting to compress blood vessels and minimize bleeding. When the bladder is distended, it can push up against the uterus and impede its ability to contract, leading to uterine atony. The best sign that hemorrhage risk is present from this atony is a boggy, soft uterus paired with heavy lochia. A soft uterus indicates poor tone and inability to compress bleeding vessels, while heavy lochia shows ongoing significant bleeding rather than the small, expected amount of lochia after delivery.

Other signs—such as a firm uterus with scant lochia (indicating good contraction and minimal bleeding), a uterus displaced and deviated fundus (which can suggest bladder distension but not directly the atony causing hemorrhage), or no lochia discharge (which is not typical postpartum and could indicate other issues)—do not point as clearly to atony-driven hemorrhage due to bladder distension.