Postpartum hemorrhage (PPH) is a potentially serious obstetric complication in which a patient bleeds excessively after giving birth. Soon after the delivery of the baby, the uterus will usually contract to deliver the placenta and then compress the blood vessels that were attached to it. When the uterus does not contract properly it is referred to as uterine atony and it is the most common cause of PPH. If these contractions are too weak, the blood vessels are able to continue bleeding freely.
Fundal massage, also known as uterine massage, is a technique used to encourage the uterus to contract properly both during and after the delivery of the placenta. It involves applying repetitive massaging or squeezing motions to the woman’s abdomen in order to stimulate the contraction.
When to intervene?[edit | edit source]
- Continued Heavy Bleeding. Although some level of postpartum bleeding is normal, heavy bleeding which does not abate after delivery of the placenta is a potentially life-threatening event and requires immediate intervention. Note: delivery of clotted blood is normal and not necessarily a sign of continued active bleeding.
- Soft or "boggy" uterus. When treating a patient with PPH, a fundal massage should only be performed if the uterus is soft. A uterus that is firm, central and contracting properly (about the size of a grapefruit) does not require massaging; this may worsen bleeding or disrupt the normal placental separation post-birth
Uterine Massage Technique[edit | edit source]
To perform uterine massage in the prehospital environment, one hand is placed just above the symphysis pubis to support the lower uterine segment while the other hand is placed on top of the fundus, firmly massaging it in a circular motion towards the supporting hand. This should be repeated every 10 minutes during transport if bleeding is continuing, or the uterus feels “spongey”, “boggy” or soft rather than firm like a basketball. Clots may be expelled during contraction.
The mother should also be encouraged to breastfeed the newborn as this will help to stimulate uterine contractions.
