امرأة بعد ولادة طبيعية لطفل وزنه ٤٫٣ كغ قبل ساعة، الرحم لين ومرتفع فوق السرة، ونزفت ٩٠٠ مل. النبض ١١٨، والضغط ٩٤/٥٨. المثانة ممتلئة. ما أول إجراء؟

A woman an hour after vaginal delivery of a 4.3 kg baby has a soft uterus above the umbilicus and has lost 900 mL. HR 118, BP 94/58; her bladder is full. What is the first action?

1. Give analgesia and wait half an hour
2. Pack the vagina with gauze and keep her lying flat
3. Massage the fundus, empty the bladder and call for help
4. Encourage walking to reduce bleeding

Answer: C) Massage the fundus, empty the bladder and call for help. PPH from uterine atony (commonest): fundal massage, empty the bladder, oxytocin and other uterotonics, two IVs and blood. A large baby and full bladder are risk factors.