Which maneuver helps control postpartum hemorrhage?

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Fundal massage directly addresses uterine atony, the most common cause of postpartum hemorrhage. By massaging the uterus, you stimulate its smooth muscle to contract. This contraction compresses the blood vessels at the placental site, helping to stop ongoing bleeding and firm up the uterus. To perform it, place one hand on the lower abdomen to support the uterus and use the other hand to press and knead the uterus in a circular motion, continuing until the uterus feels firm and well contracted. Once the uterus is firm, monitor for ongoing bleeding and provide additional treatments as indicated (uterotonic meds, fluids, etc.).

The other actions don’t address the underlying issue: stimulating uterine contraction won’t be achieved by an ice pack or back massage, and high-dose epinephrine isn’t a standard or appropriate treatment for postpartum hemorrhage.