If uterine massage and medications fail to control bleeding, what should be done?

Performing bimanual compression is a critical intervention when uterine massage and medications are not effective in controlling bleeding. This technique involves applying pressure to the uterus externally through the abdominal wall while simultaneously using a gloved hand internally to compress the uterus. This can help to stimulate uterine contraction, promote hemostasis, and can be an immediate, hands-on approach to managing postpartum hemorrhage.

In urgent situations where bleeding is excessive, timely actions are essential to stabilize the patient and minimize complications. While notifying the OB team and administering additional medication are important steps in comprehensive care, the skillful application of bimanual compression directly addresses the immediate risk by actively attempting to reduce blood loss through mechanical means. Waiting for natural clotting is not advisable in cases of significant hemorrhage, as it could delay necessary interventions and lead to worse outcomes for the patient.