The risk for postpartum hemorrhage increases following
a shoulder dystocia.1 The fundus should be
palpated to assess uterine contraction at least every
15 minutes during the first postpartum hour. Early
newborn breast-feeding increases endogenous maternal
oxytocin to decrease postpartum bleeding. In the
absence of breast-feeding, vigilant assessment and documentation
of maternal blood loss with exogenous
pitocin use can limit maternal blood loss. Perineal
trauma such as bruising and lacerations is common following
a shoulder dystocia. Ice packs applied to the
perineum immediately postpartum reduce edema and
perineal pain. After 24 hours, pain relief may be more
effective using warm sitz baths.