A 30-year-old woman delivered at home; placenta delivered 15 minutes ago; she continues vaginal bleeding. VS show BP 84/42, P 130, R 24. What is the immediate management?

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Immediate postpartum hemorrhage management centers on restoring uterine tone and supporting circulation so the patient can reach definitive care. When the placenta has delivered and there is ongoing heavy vaginal bleeding with hypotension, the first actions are to stimulate the uterus to contract, secure IV access for fluids, and get the patient to a facility quickly. Fundal massage helps the uterus clamp down on blood vessels at the placental site, directly reducing bleeding from uterine atony. Starting an IV allows rapid fluid resuscitation to address shock, and rapid transport gets her to a place where definitive treatments (including uterotonics and potential blood products) are available. Administering oxytocin is important, but the immediate steps in the field are massage, IV access, and rapid transport. Manual placenta removal is inappropriate here since the placenta has already delivered, and Trendelenburg is not recommended as a primary management step.