What is a key sign the nurse should monitor for that indicates uterine atony after delivery?

Monitoring for uterine atony after delivery is crucial in managing the risk of postpartum hemorrhage. A key sign to observe is prolonged postpartum hemorrhage. Uterine atony refers to the lack of muscle tone in the uterus, which is a common cause of early postpartum hemorrhage. When uterine tone is insufficient, the uterus fails to contract effectively, leading to excessive bleeding.

Prolonged postpartum hemorrhage is an indication that there may be uterine atony, as the uterus is not contracting as it should to reduce blood flow from the placental site. If the nurse notices excessive bleeding that continues beyond the expected amount in the early postpartum period, this could indicate that the uterus is not responding properly, warranting immediate assessment and intervention.

In contrast, while increased lochia rubra may be associated with uterine atony, it is not as definitive on its own. Severe abdominal pain can indicate a variety of conditions but is not a specific marker for uterine atony. Uterine firmness is actually a sign of effective uterine tone; a firm uterus indicates good contractions and a lower risk of bleeding. Therefore, prolonged postpartum hemorrhage stands out as the most critical sign to monitor in the context of uterine atony.