Assessing the uterus immediately following delivery is a routine procedure necessary to monitor the mother’s recovery. The fundus, the topmost portion of the uterus, provides direct information about how the organ is contracting after childbirth. This postpartum check is a foundational part of care during the first few hours and days following birth. The primary goal is to ensure the uterus is returning to its pre-pregnancy state, a process known as involution.
The Purpose of Fundal Assessment
Monitoring the fundus is primarily a preventative measure against excessive bleeding, a major concern in the immediate postpartum period. After the placenta is delivered, the uterine muscle fibers must contract tightly to constrict the blood vessels. This contraction acts as a natural tourniquet to stop blood flow.
If the uterus fails to contract firmly, a condition known as uterine atony, the blood vessels remain open, leading to a high risk of postpartum hemorrhage (PPH). A uterus that is not contracted is often described as “boggy” or soft to the touch. The nurse’s assessment focuses on verifying the uterus is hard and firm, similar to a contracted muscle. Checking the fundus allows the nurse to detect signs of atony early, enabling immediate intervention.
Performing the Assessment Procedure
The nurse begins the assessment by ensuring the patient is lying flat on their back with their knees slightly bent to relax the abdominal muscles. Patient comfort and privacy are maintained throughout the procedure. A two-handed technique is used for safe and accurate palpation.
The nurse places one hand, often the non-dominant one, just above the pubic bone to stabilize the lower uterine segment. This support prevents the uterus from being pushed down into the pelvis during the assessment. The other hand gently palpates the abdomen, moving downward from below the ribs toward the umbilicus.
Once the firm, rounded fundus is located, the nurse assesses its firmness and location. Firmness is checked by applying gentle pressure; a healthy finding is a firm, hard feel. The height is measured in relation to the umbilicus using fingerbreadths or centimeters. For instance, “U/1” or “U+1” indicates the fundus is one fingerbreadth above the umbilicus, while “1/U” or “U-1” means it is one fingerbreadth below.
Understanding Normal Uterine Involution
Immediately after the delivery of the placenta, the fundus is normally palpable near the level of the umbilicus or slightly below it. This position indicates that the uterus has begun involution effectively. Within the first 12 hours postpartum, the fundus may temporarily rise about 1 centimeter before beginning its steady descent.
The uterus decreases in size at a predictable rate, descending approximately one fingerbreadth or 1 centimeter every 24 hours. By the fifth or sixth postpartum day, the fundus is usually located halfway between the umbilicus and the pubic bone. By 10 to 14 days postpartum, the uterus should have returned to the pelvic cavity and should no longer be palpable abdominally.
Identifying Deviations and Immediate Action
The most significant deviation is a fundus that feels “boggy” or soft, signaling uterine atony and a high risk of PPH. If the nurse encounters a boggy fundus, the immediate intervention is fundal massage. The nurse uses the heel of their hand to firmly massage the uterus until it contracts and becomes firm.
Another abnormal finding is a fundus that is displaced laterally, which often indicates a full and distended bladder. A full bladder prevents the uterus from contracting effectively, increasing the risk of bleeding. The nurse’s first action is to assist the patient in emptying their bladder, either by encouraging them to void or, if necessary, by catheterization. The fundus should also not be higher than expected for the day postpartum, as this suggests a lack of contraction or bladder distention.