When might further evaluation be necessary post-fundal massage?

Further evaluation is necessary following a fundal massage if the fundus remains boggy. A boggy fundus indicates that the uterus is not contracting effectively, which can result in increased risk for postpartum hemorrhage. After delivery, the uterus should contract firmly to decrease its size and minimize bleeding. If fundal massage does not result in a firm uterus, it necessitates further assessment and intervention to identify potential causes of uterine atony and to ensure appropriate management to prevent complications.

The other choices do not warrant further evaluation in the same manner. Lack of blood loss does not relate to the effectiveness of the fundal massage, as a boggy fundus can occur even in the absence of blood loss. A mother reporting no pain may indicate comfort but does not provide pertinent information about uterine tone. Similarly, a crying baby does not impact the need for further evaluation of the mother’s condition post-massage. Thus, the focus on the firmness of the fundus is key in determining the need for additional evaluation and intervention.