In field management of postpartum hemorrhage when possible, which step is essential?

• A. Establish airway and breathing, secure IV access, monitor vitals, and provide rapid transport per protocol; uterine massage if directed.
• B. Immediately transport without starting IV or airway management to save time.
• C. Only perform uterine massage; no airway or IV.
• D. Withhold airway management unless speech is impaired.

Answer: (A)

The key idea is to stabilize the patient first. In field management of postpartum hemorrhage, the priority is to ensure the patient is making it to a facility safely while you address life-sustaining needs. This means securing the airway and ensuring adequate breathing so the patient doesn’t become hypoxic, establishing IV access to start fluids or medications, and continuously monitoring vital signs to detect deterioration early. At the same time, initiating rapid transport per protocol gets the patient to definitive care as quickly as possible.

Uterine massage is included when directed because a boggy uterus is a common source of postpartum bleeding, and manual massage helps stimulate uterine contraction to help control bleed locally. Having these steps in place—airway/breathing support, IV access, monitoring, and expedited transport—provides both immediate stabilization and a path to definitive treatment, which is essential in PPH.

Why not delay these steps? Skipping airway or IV access or delaying transport wastes critical time and can allow shock to worsen. Focusing only on uterine massage without maintaining airway and IV access leaves the patient vulnerable to rapid deterioration, and delaying airway management until speech issues appear is unsafe, as airway compromise can occur before any speech changes.