From the Guidelines
Uterine massage is a crucial procedure after childbirth to ensure the uterus remains contracted and prevent postpartum hemorrhage, with the primary goal of stimulating the myometrium to contract and compress blood vessels at the placental site, reducing bleeding. The most common cause of early postpartum hemorrhage is related to uterine atony, which can be initially treated by uterine massage and uterotonic drugs such as oxytocin, as stated in the study by 1. To perform uterine massage, one should place one hand on the lower abdomen just above the pubic bone while the other hand gently but firmly kneads the top of the uterus (fundus) in a circular motion.
Key Points to Consider
- The massage should continue until the uterus feels firm like a grapefruit, as a soft or "boggy" uterus indicates the need for increased massage frequency.
- Oxytocin is typically administered alongside massage to enhance uterine contraction, with a dosage of 10-40 units in 1L IV fluids or 10 units IM, as supported by the study 1.
- Uterine massage should be performed every 15 minutes for the first 2 hours after delivery, then less frequently as the uterus remains contracted.
- Patients should be taught to self-massage before discharge, as uterine atony can occur days after delivery, highlighting the importance of continued monitoring and self-care.
Additional Considerations
- If massage fails to maintain uterine contraction, additional interventions such as additional uterotonics (methylergonovine, misoprostol) may be necessary, as indicated in the study by 1.
- The diagnosis of retained products of conception (RPOC) is helpful to the clinician in determining whether surgical intervention is warranted, as RPOC is the second most common etiology for postpartum hemorrhage after uterine atony.
From the FDA Drug Label
To control postpartum bleeding, 10 to 40 units of oxytocin may be added to 1,000 mL of a nonhydrating diluent and run at a rate necessary to control uterine atony The purpose of uterine massage is not explicitly mentioned in the provided drug labels. However, uterine atony can be controlled with oxytocin infusion, and uterine massage is often used to help the uterus contract and reduce bleeding after delivery.
- The labels do not directly address the purpose of uterine massage, but they do discuss the use of oxytocin to control postpartum bleeding and uterine atony 2.
- Uterine massage may be used to help the uterus contract and reduce bleeding, but this is not explicitly stated in the labels. The FDA drug label does not answer the question.
From the Research
Purpose of Uterine Massage
The purpose of uterine massage is to help the uterus remain contracted and reduce postpartum blood loss. This technique is recommended as part of the routine active management of the third stage of labor [ 3 , 4 ].
Benefits of Uterine Massage
The benefits of uterine massage include:
- Reduced postpartum blood loss [ 3 , 4 , 5 ]
- Decreased need for additional uterotonics [ 3 , 4 , 5 ]
- Potential to reduce maternal mortality and morbidity [ 3 , 6 ]
Effectiveness of Uterine Massage
The effectiveness of uterine massage in reducing postpartum blood loss and preventing postpartum hemorrhage is supported by several studies [ 3 , 4 , 5 ]. However, one study found that uterine massage was less effective than oxytocin in reducing blood loss after delivery [ 7 ].
Limitations and Future Research
The current evidence on the effectiveness of uterine massage is limited by the small number of studies and the variability in their results [ 3 , 4 ]. Further research is needed to fully understand the benefits and limitations of uterine massage in preventing postpartum hemorrhage [ 3 , 6 ].