Fundal palpation (postpartum)
Description
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After birth, the uterus gradually shrinks and descends into its prepregnancy position in the pelvis; termed involution.
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Palpation of the uterine fundus postpartum helps to determine uterine size, degree of firmness, and rate of descent, which is measured in fingerbreadths above or below the umbilicus.
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The involuting uterus should be at the midline.
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The fundus is usually midway between the umbilicus and symphysis 1 to 2 hours after delivery, 1 cm above or at the level of the umbilicus 12 hours after delivery, and about 3 cm below the umbilicus by the third day after delivery.
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The fundus will continue to descend about 1 cm/day until it isn’t palpable above the symphysis (about 9 days after delivery).
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The uterus decreases to its prepregnancy size 5 to 6 weeks after delivery, not from a decrease in the number of cells but from a decrease in their size.
Equipment
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Gloves
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Perineal pad
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Urinary catheter (optional)
Essential steps
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Before palpating the uterus, explain the procedure to the patient and provide privacy.
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Wash your hands and put on gloves.
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Ask the patient to urinate. If she’s unable to urinate, anticipate the need to catheterize her.
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Lower the head of the bed until the patient is in a supine position or her head is slightly elevated.
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Expose the abdomen for palpation and the perineum for inspection.
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