The fundus is the dome-shaped, uppermost portion of the uterus. It expands significantly during pregnancy to accommodate the growing fetus. Immediately following childbirth, the postpartum fundal assessment is a standardized nursing procedure. A nurse performs this check by measuring the height and evaluating the consistency of the uterus through the abdominal wall. This physical examination monitors how the uterus is recovering and returning to its non-pregnant state.
The Purpose of Postpartum Fundal Assessment
The primary clinical purpose of checking the fundus is to monitor uterine involution, which is the process of the uterus shrinking back down toward its pre-pregnancy size. Contractions of the uterine muscle fibers drive this process, effectively clamping down on the blood vessels that were connected to the placenta. This contraction is a natural mechanism for achieving hemostasis.
Inadequate uterine contraction, a condition known as uterine atony, is the single most frequent cause of postpartum hemorrhage. The fundal assessment serves as the main tool for the early detection of uterine atony. Regular checks allow the nursing staff to identify a uterus that is not contracting properly before excessive blood loss occurs.
The assessment also helps to ensure the uterus is positioned correctly in the abdomen. A full bladder can interfere with involution by pushing the uterus out of its normal midline position. Recognizing these deviations allows the nurse to intervene promptly.
Step-by-Step Fundal Height Measurement
The procedure begins by ensuring the patient is positioned correctly, typically lying flat on her back (supine) with knees slightly flexed to relax the abdominal muscles. The nurse must first explain the procedure and obtain consent, as the assessment can sometimes cause temporary discomfort.
The nurse uses a two-handed technique to perform the assessment, which is crucial for safety and accuracy. The non-dominant hand is placed just above the symphysis pubis, the bony joint at the front of the pelvis, to provide firm support to the lower uterine segment. This support prevents the uterus from being pushed downward into the vagina during palpation.
With the supporting hand in place, the dominant hand gently palpates the abdomen to locate the fundus, which should feel like a firm, rounded mass. Once the fundus is located, the nurse determines its height by measuring its position in relation to the umbilicus. This measurement is often expressed in fingerbreadths, or approximately one centimeter increments, above or below the umbilicus.
For instance, a finding may be documented as “U/U” (at the level of the umbilicus), “U-1” (one fingerbreadth below the umbilicus), or “U+1” (one fingerbreadth above the umbilicus). Accurate measurement and documentation of this position are essential to track the expected progressive descent of the uterus over time.
Interpreting Assessment Findings
The firmness of the fundus is a direct indicator of the effectiveness of uterine contraction. A fundus that feels firm, hard, and well-contracted, similar to the feel of a grapefruit, is the desired finding and signifies the uterine muscle fibers are effectively constricting blood vessels. Conversely, a soft, mushy, or “boggy” fundus indicates uterine atony, meaning the uterus is not contracting adequately to stop the bleeding.
If the nurse discovers a boggy fundus, the immediate and primary action is to perform a fundal massage using a gentle, circular motion until the uterus firms up. This physical stimulation manually prompts the uterine muscles to contract and is typically followed by a reassessment of bleeding. The patient’s physician or a medical provider is immediately notified of a persistently boggy fundus, as this finding significantly increases the risk of postpartum hemorrhage.
The position of the fundus is also important for interpretation, as it should be located in the midline of the abdomen. If the fundus is displaced laterally, or pushed to the left or right side, it most commonly suggests a full bladder is obstructing the uterus from contracting properly. In this scenario, the nurse’s first intervention is to encourage the patient to empty her bladder, as a distended bladder can also contribute to uterine atony.
Immediately after delivery, the fundus is typically expected to be found at or slightly below the level of the umbilicus. Over the next 24 hours, the uterus generally descends by approximately one fingerbreadth per day. By about one week postpartum, the fundus should be located at the symphysis pubis. By two weeks, it should no longer be palpable above the pelvic bone.