Uterine palpation is a method of physical examination that involves using touch to assess the uterus. This technique offers insights into uterine health, particularly during pregnancy and the postpartum period. It provides a way to monitor the uterus’s size, position, and consistency, which can be indicators of normal physiological changes or potential issues.
Purpose of Uterine Palpation
Uterine palpation serves several purposes, especially in the context of pregnancy and childbirth. During pregnancy, healthcare providers use it to estimate fundal height, which is the distance from the pubic bone to the top of the uterus. This measurement helps in assessing fetal growth and development, and also in verifying the gestational age of the pregnancy. Fundal height measurements, typically started around 20 weeks of pregnancy, can indicate if a fetus is growing as expected or if there might be concerns like restricted growth or an unusually large size.
After childbirth, palpation monitors uterine involution, the process by which the uterus returns to its pre-pregnancy size and position. A healthcare provider will check if the uterus feels firm and is descending appropriately, as a soft or “boggy” uterus postpartum can indicate uterine atony, a condition where the uterus fails to contract adequately. This lack of contraction can lead to excessive bleeding, known as postpartum hemorrhage. Palpation can also help identify other postpartum issues, such as retained placental fragments, which can cause heavy bleeding and infection.
Uterine Changes Through Stages
The uterus undergoes significant transformations, particularly throughout pregnancy and the postpartum phase. Before pregnancy, the uterus is about the size of a pear, measuring approximately 3 inches long and 2 inches wide, weighing around 1 ounce. As pregnancy progresses, this remarkable organ expands considerably to accommodate the growing fetus.
Uterine Changes During Pregnancy
By about 12 weeks of gestation, the uterus enlarges to roughly the size of a grapefruit and begins to rise out of the pelvis, becoming palpable just above the pubic bone. Around 20 weeks, its top typically reaches the belly button. It continues its ascent, reaching its highest point near the rib cage between 28 and 36 weeks of pregnancy.
Uterine Changes Postpartum
After childbirth, the uterus immediately begins involution, contracting to reduce in size and descend back into the pelvis. Within an hour of delivery, its top is typically near the navel, descending about 1 centimeter daily. By 10 to 14 days postpartum, it usually returns to the pelvic cavity, regaining nearly its pre-pregnancy size and weight by six weeks.
Steps for Self-Palpation
To perform self-palpation, begin by lying on your back with your knees bent and feet flat on the surface. This position helps relax the abdominal muscles, making it easier to feel the uterus. Ensure your hands are warm to avoid causing the uterus to contract unnecessarily.
Place the palm of one hand gently on your lower abdomen, just above the pubic bone. Slowly and softly press down with the pads of your fingers, moving your hand upward toward your navel. Feel for a firm, rounded mass—your uterus. If pregnant, it will feel firm, smooth, and movable. Postpartum, it should feel firm and roughly the size of a grapefruit shortly after delivery, gradually becoming smaller and descending lower into the pelvis.
Understanding Your Findings and When to Consult a Professional
During pregnancy, a normally growing uterus feels firm, and its top, or fundus, should align with your gestational week in centimeters after about 20 weeks. After childbirth, a normal uterus should feel firm and be contracting, gradually descending into the pelvis.
However, certain findings warrant immediate consultation with a healthcare professional. If your uterus feels unusually soft or “boggy” after childbirth, this could indicate uterine atony, which increases the risk of excessive bleeding. Persistent pain, heavy bleeding with clots, foul-smelling vaginal discharge, or fever after delivery may signal an infection or retained placental tissue. If pregnant, unexpected rapid growth, slow growth, or a uterus that feels unusually hard or tender require medical evaluation. Self-palpation is a helpful tool for self-awareness, but not a substitute for professional medical assessment.