What is the first step in managing severe postpartum hemorrhage?

• A. Administer a uterotonic agent
• B. Control external perineal bleeding by applying direct pressure to any visible lacerations
• C. Begin rapid IV infusion
• D. Begin active warming

Answer: (B)

In severe postpartum hemorrhage, the fastest way to reduce blood loss is to stop bleeding at its source. If there are visible perineal or vaginal lacerations, applying direct pressure to those sites can rapidly tamponade the bleed, buy time, and stabilize the patient while other measures are started. This immediate action address external bleeding right away, which is crucial before or alongside giving uterotonic drugs to treat potential uterine atony and arranging rapid resuscitation with IV access and warming. Other steps remain essential, but controlling any visible lacerations with direct pressure is the quickest initial move.