What is the primary immediate management step for suspected atonic hemorrhage?

The primary immediate management step for suspected atonic hemorrhage is fundal massage. After delivery, particularly in cases of suspected uterine atony, a loss of tone in the uterine muscles can lead to excessive bleeding. Fundal massage stimulates the uterus to contract and helps to restore its tone, effectively reducing the risk of further hemorrhage.

This action can often be performed quickly and is a key component of postpartum care. The tactile feedback provided by fundal massage not only allows the healthcare provider to assess the firmness of the uterus but also actively encourages the muscles to contract, thereby controlling blood loss from the placental site. Immediate response with fundal massage is crucial in the management of atonic hemorrhage as it addresses the underlying issue directly.

In contrast, other options such as uterine artery embolization are more invasive procedures that would not be the first line in the immediate management of atonic hemorrhage. An IV fluid bolus may be necessary later if there is significant hypovolemia, but the immediate concern is to stop the hemorrhage, which fundal massage directly addresses. Antibiotics may be necessary for other conditions, but they do not help control an active hemorrhage.