What is the most likely cause for early decelerations in the fetal heart rate (FHR) pattern?

• White blood cell count: Expected—mild leukocytosis is normal postpartum due to physiological stress.
• Blood clot size: Expected—small clots, like a pea-sized clot, are common and not concerning unless excessive bleeding occurs.
• Uterine findings: Expected—firm and midline uterus indicating effective involution.
• Lochia findings: Expected—progressing normally without signs of infection (no foul odor).
• Calf findings: Expected—a single varicose vein without tenderness or swelling is not concerning.
• Blood pressure: Expected—within normal postpartum range.

Choice A rationale

Assessing vital signs is important in evaluating a postpartum hemorrhage, but it is not the immediate priority. Significant blood loss can occur before changes in vital signs become apparent due to compensatory mechanisms in the body. Addressing the source of bleeding is the initial critical step.

Choice B rationale

Calling the primary health care provider is a necessary step, but it should occur after the nurse has taken immediate action to address the likely cause of the excessive bleeding. Direct intervention to control the hemorrhage takes precedence over notification.

Choice C rationale

Massaging the fundus is the highest priority because uterine atony, a soft and boggy uterus that does not contract effectively, is the most common cause of early postpartum hemorrhage. Stimulating uterine contraction by massage can help to compress the blood vessels at the placental site and reduce bleeding.

Choice D rationale

Initiating an intravenous (IV) infusion of Ringer's lactate solution is important for volume replacement if bleeding is significant, but it is not the immediate first action. Addressing the uterine atony through fundal massage should be done first to try and control the bleeding.