Initial steps (addressing uterine atony) Uterine massage: If the uterus is "boggy" (not firm), manually massage the fundus to stimulate contractions. Empty the bladder: A full bladder can prevent the uterus from contracting properly, so a catheter should be used to empty it. Fundal pressure: Apply pressure to the fundus to help with contraction Medications Uterotonics: These are often the first-line medical treatment to cause the uterus to contract. Oxytocin: The first-choice drug, given intravenously or intramuscularly. Methylergonovine: Can be used if oxytocin is not effective, but is contraindicated in women with high blood pressure. Carboprost: A prostaglandin that is effective but should be avoided in women with asthma. Supportive care Fluid and blood replacement: For significant blood loss, fluid resuscitation with IV crystalloids and blood product transfusion (packed red blood cells, platelets, fresh frozen plasma) is crucial. Monitoring: Close monitoring of vital signs and blood counts is essential.