In cases of severe postpartum hemorrhage, what should be the first step in management?

In cases of severe postpartum hemorrhage, performing uterine massage is the appropriate first step in management because it directly addresses one of the most common causes of postpartum bleeding: uterine atony. Uterine atony occurs when the uterus fails to contract effectively after delivery, leading to excessive bleeding. By initiating uterine massage, you help stimulate uterine contractions, which can reduce bleeding and stabilize the patient's condition.

Uterine massage is a quick and non-invasive intervention that can be carried out immediately after identifying severe hemorrhage, making it the most logical first step in the management of this critical situation. Once this intervention is initiated, other treatments such as intravenous fluids or blood products can be considered based on the patient's ongoing assessment and response to the massage.