What are signs of uterine atony after delivery?

Heavy vaginal bleeding and a boggy uterus on palpation are definitive signs of uterine atony after delivery. Uterine atony is characterized by the failure of the uterine muscles to contract effectively after childbirth, which can lead to excessive postpartum hemorrhage. A boggy uterus, which feels soft rather than firm upon palpation, indicates inadequate muscle tone and contraction, while heavy vaginal bleeding signifies that the uterus is not constricting the blood vessels effectively, allowing for significant blood loss.

In contrast, prolonged labor and increased fetal heart rate pertain more to conditions during labor rather than postpartum evaluation. Swelling of the abdomen with decreased fetal movement would be relevant in the context of pregnancy rather than post-delivery assessments. Intense uterine contractions and fever may suggest uterine involvement but do not directly indicate uterine atony; they more likely point to other conditions such as infection or retained products of conception. Thus, the combination of heavy vaginal bleeding and a boggy uterus best characterizes uterine atony and is the most accurate choice.