fundal checks

Specialties Ob/Gyn

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What is the protocol for fundal checks on c-section pts? As far as frequency goes?

Specializes in learning disabilities/midwifery.

I guess here its just that its another intervention thats generally not needed so why make all women go through what can be a very painful experience if there's not a clinical need to do it. Most of our maternity care is based around the principle that if there's no real justified clinical need to do an intervention then we dont do it. Ive only twice had post c/s women show clinical signs that suggested the need for fundal assessment (although I admit Ive only been doing this for 3 years so have limited clinical experience compared to others)

I actually had a look through our national guidelines after I posted the last time to see what they say and fundal checks arent mentioned at all in our post-c/s care guidelines. As far as post SVD women the guidelines state that checks are not required unless clinical condition suggests a need.

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Specializes in Rural Health.

Our sections go to PACU, so I don't know what their protocol is. We check once upon admission to our floor and then we check with our shift assessment. We have the option to check more if there is a clinical indication to do so. However, we do have 2 doctors that specifically write no fundal checks after a C-section and if there is a concern, page them and they'll come in and see the patient. Their rationale is that after major abd. surgery we do not need to be poking and "messing around" with their work.

SVD we do fundal checks Q15 mins for 2 hours. At the 2 hour mark we try and get the patient up and ambulating around the room, to the bathroom, etc.... and then we check again. As long as it stays firm after the first trip around the room, we go to checks with our shift assessment unless there is a reason to do more.

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What is the protocol for fundal checks on c-section pts? As far as frequency goes?

I had a case this summer when I externed that I was told by the physician was rare, but if the nurse hadn't been doing frequent fundal checks post-c-section, it may have turned into something serious.

The patient's fundus, post-delivery, was going UP not down. She was also totally absent of bleeding..and when I mean none, I mean none. Not a drop.

She had blood that had coagulated over her cervix and would not allow blood to flow out. The OB was called back in to open up her cervix, remove the clot, and her fundus came down very quickly after that.

We were taught in school that absence of lochia is a sign of infection...now I know of another reason why you won't see it.

So obviously, I think checking the fundus frequently right after a delivery is very important!

The hospital did not have a standard protocol that I was aware of for fundal checks, however, all the L&D nurses did check them very frequently post delivery, and when they did a couple of checks that were normal, they did them once per shift after that unless there was a change in flow.

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Specializes in mother/baby.

On the postpartum floor where I work, we do C/S fundal checks:

On admission from PACU, then Q1H x 4, then Q4H x 2, and then Q8H until advanced to "wellness care" (usually 24 h after delivery, unless there's a complication). Once on 'wellness care', we do Q12H.

I'm just finishing my new grad orientation, but I did see one pt who had an order for no fundal checks. This was b/c the bladder had been nicked and repaired during surgery, and my understanding was that the doctor didn't want us poking at it b/c of that.

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Specializes in OB, lactation.

Fundal checks are definitely a mainstay for any postpartum pt on our unit. I have never had an order not to do them - even with bladder nicks, etc.

For those ofyou who don't routinely do them... what all do you assess? I am curious, because I have patients occasionally who are tricky on external exam for bleeding... normal on outside but pooling on the inside with clots and boggy uterus. I would be nervous to not do fundal checks, but maybe it's just what I'm used to. Or, maybe something in our labor or postpartum routine is different that encourages more postpartum bleeding. (For example, lots of long pit inductions!) Also, what are your patients given for bleeding after lady partsl/cesarean delivery (pitocin, methergine, etc.?)? We give 20units of Pit IV. Also, our placentas are helped out quickly, 99% of the time within 2-5 minutes of delivery.

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Specializes in learning disabilities/midwifery.

For those of you who don't routinely do them... what all do you assess?

For our post C/S women our routine assessments include BP, Pulse, Temp, Resps, O2 sats, lochia, pain, leg/calf pain, itching, nausea, alertness, urine output.

We do these every 5 mins x4, then every 15mins x2, every 30 mins x2. Then women move from our recovery area to our post natal wards where their observations are carried out twice daily and then only BP, pulse, temp, lochia, leg pain.

For our post SVD women we assess basic obs, BP, Pulse, temp, lochia, fundus immediately post delivery of placenta, then we would check lochia and fundus after @15 mins, once more prior to them getting up (if they've been in bed that is) and then the whole set of basic obs again prior to going to post natal ward.

Obviously this would change in frequency should clinical condition dictate it.

As far as our third stage management is concerned we use Syntocinon 10iu IM on delivery of the anterior shoulder For women who are deemed high risk (previous major PPH, para 5 or above, vbac) we use Syntocinon 5iu IV plus Syntometrine 1amp IM.

We also have quite a few physiological third stages however their management doesnt change from other women as far as observations are concerned.

With managed 3rd stages we have most of our placentas delivered within 5-10 minutes although we are happy to wait 30 minutes before getting the docs involved (we'd have tried all the 'tricks' before this though!) With physiological 3rd stages we have an hour before we'd consider intervening.

Hope that helps.

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Specializes in L& D / GI NURSE.
L/D does fundal checks q15min x 4, then when mother/baby gets the pt, we do check q30min x 3, q4h x 48 hrs, then qshift. For vag dels, we do the same q15 and q30, then q4x3 and then BID. Obviously in any case we can check more often if we are worried about something. I have never personally seen a doc specifically order no fundal checks on a post c/s but I have heard of it happening.

Only, one time i remember we had a c/s patient whose bladder was nic during deliver ..... but we were ordered not 2 do fundal checks because of her abdominal aortic aneurysm( sp?).....

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Specializes in Labor and Delivery.

Our policy is q15 min x4, q 1hr x4, then q 8 hours. Of course if we have a patient that is not staying firm (even with an empty bladder), soaking her pads within an hour etc. we check here more frequently and document....alot!

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Specializes in OB.

You should always check your hospital's policy book for their policy for fundal checks. In our hospital we check q 15 min for 2 hours then q 4 for 24 hours then q 8 until discharge. Now this is for "run of the mill" deliveries. If there is any inclination that my patient is predisposed to excessive bleeding, then I would increase my q 15 for another hour or so.

Word to the wise: Careful of vigorous massages on multips without good support to the bottom of the fundus...I've seen uteruses prolapse because of this not being done. :uhoh21:

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Specializes in OBGYN, Neonatal.

I'm in mother/baby post partum so we get c/s patients usually 2 hours post delivery. We do fundal checks and vital signs q30 mins x 2 hours and then q60 mins x 2 hours and then q4 hours, then qshift. :) It gets confusing after awhile LOL! I feel like live on the fundus somedays LOL!

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Specializes in Obs.

I work L&D, and we recover our patients post C-section (also scrub and circulate in the OR), until they are ready for transfer to postpartum.

For sections, we do fundal checks, vitals, etc. q15 min while they are in PACU, then on PP I believe it is q30x2, q1hx4, then q shift...they may not do the q30 checks anymore, I'm not 100% on that anymore. For a vag delivery, q20x4, q1hx4, then q shift.

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Specializes in Midwifery.

We don't palpate fundus' on post CS women - too painful. The only time I would do it is if I'm concerned that the woman has a uterus full of clot. Our vag births get done 1/2 hrly for 2 hours and then once per shift or 3 times per day. I also teach women to do it themselves.

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