Fundal Measurement - Postpartum

nursejohio, ASN, RN · Sep 4, 2008

I like my pp moms to be at umbilicus or lower immediately after delivery. The height can depend on gestational age of baby, single or multiples, if she's a primip or multip. I very rarely notice that fundal height decreases in the 2 or so hours I have for recovery. It shouldn't get higher though, that can indicate moms bladder is full or she's hanging on to a blood clot in there

iteachob, MSN, RN · Sep 4, 2008

Midway between the symphysis and umbilicus immediately following delivery? No, that would occur on about day 6 post partum (Lowdermilk & Perry, 9th ed). At the end of the 3rd stage the uterine fundus is about 2 cm above the umbilicus (although I don't like to see it this high), within 12 hours about 1 cm above the umbilicus and at 24 hours at about the level of the umbilicus (also Lowdermilk & Perry, 9th ed).

justme1972 · Sep 4, 2008

Great information has been posted. I did have something very unusual happen this summer that an OB said he had only seen twice in 7 years.

We had a Mom that had a c-section (scheduled) and when we took her out of the OR to check her bleeding..there was none...and when I mean none, I mean none..WHITE glove went in....white glove came out.

They taught us in school, that no bleeding could be a sign of infection...but I knew this possibility to be just short of non-existent b/c this Mom had no fever and this was scheduled...not like PROM or anything like that.

Her fundus? Within 45 minute of delivery kept going up to about 4+ and rising.

We called the doctor (the rush was b/c her spinal was still working)...he came in, opened up her cervix, and there was a blood clot that had sealed off the cervix and everything came gushing out.

Within an hour her fundus was right where it should be.

It was a good lesson and a good experience.

SmilingBluEyes · Sep 4, 2008

Hopefull2009 said:
Great information has been posted. I did have something very unusual happen this summer that an OB said he had only seen twice in 7 years.
We had a Mom that had a c-section (scheduled) and when we took her out of the OR to check her bleeding..there was none...and when I mean none, I mean none..WHITE glove went in....white glove came out.
They taught us in school, that no bleeding could be a sign of infection...but I knew this possibility to be just short of non-existent b/c this Mom had no fever and this was scheduled...not like PROM or anything like that.
Her fundus? Within 45 minute of delivery kept going up to about 4+ and rising.
We called the doctor (the rush was b/c her spinal was still working)...he came in, opened up her cervix, and there was a blood clot that had sealed off the cervix and everything came gushing out.
Within an hour her fundus was right where it should be.
It was a good lesson and a good experience.

Unfortunately, this has happened with a few patients of mine. The clot acts like a "cork" so to speak, and can cause HUGE problems. If this ever happens again, be sure to call your OB very early-on to come in and evaluate! They can do a sterile "sweep" with a glove, in some cases (as this often happens with lady partsl births)--- and remove such things before they become a problem. Time is really of the essence here; that I have learned the hard way some years back. A uterus rising this much is definitely a problem---should not happen.

Good lesson for us; thanks for sharing!

SmilingBluEyes · Sep 4, 2008

iteachob said:
Midway between the symphysis and umbilicus immediately following delivery? No.....that would occur on about day 6 post partum (Lowdermilk & Perry, 9th ed). At the end of the 3rd stage the uterine fundus is about 2 cm above the umbilicus (although I don't like to see it this high), within 12 hours about 1 cm above the umbilicus and at 24 hours at about the level of the umbilicus (also Lowdermilk & Perry, 9th ed).

RULE OF THUMB: about a finger-breadth a day, is the norm! Deviations from this can occur, of course, but this is a good general rule.

Be sure to check for deviation of the fundus to right or left; this can indicate an overfull or distended bladder.

Elvish, BSN, DNP, RN, NP · Sep 5, 2008

I have had the clot-blocking-cervix problem several times too. If I have a mom whose uterus is just not at u or below, and her bladder isn't distended, I get my panties in a wad. Once we pulled a clot the size of a volleyball (no, not exaggerating) out of a uterus. It wasn't pretty.

bagladyrn, RN · Sep 5, 2008

I've also noticed that when there are clots in the uterus, the fundus tends to feel "lumpy" rather than smoothly rounded. If good fundal massage doesn't result in passing those clots, it's definitely time to have the provider come in and assess.

Lack of lochia in a postop c/section would also make me wonder if there is a "leak" somewhere into the abdominal cavity from the uterine incision (rare, but have seen a pt. go back to OR for this). That blood has to be going somewhere!

NurseNora, BSN, RN · Sep 6, 2008

The textbooks do say that the fundus rises a little in the fist 12 hours and then starts getting lower. Not sure I've found this to be consistently true in my practice. I've rarely seen a fundus as low as your textbook describes immediately after delivery--maybe a young primip with a small baby.

I've always used the "+" to indicate above the umbilicus, and a "-" to indicate below, but I'm not sure your text is using it in the same way. That's why I like to use 1/U for above and U/1 for below.

The most important thing is that the fundus is staying at or below where it has been previously measured. And that the flow is also about the same.

zahryia, LPN · Sep 8, 2008

Yayamaya said:
I wanted some clarification please on fundal height measurement. In my textbook, it says that the fundus immediately after delivery should be midway between the symphisis and umbilicus, after 1 hour 1 cm above and within 12 hrs should be 1+ which I am assuming is below....
Does the plus indicate below the umbilicus? Why would it be midway right after delivery and then move further up 12 instead of further into the pelvis?
Would really appreciate this information!!
Thanks so much.

I think the read the same thing. It's always confused the hell out of me. I'm glad to see this is incorrect. All my fundal checks (so far) have been at U or -1. I think I might have had one mom with a +1.

cassioo, RN · Sep 11, 2008

The word is immediate. Immediately it is low but within usually 15 minutes it's at the umbilicus. I agree with all the comments about clots and bladder distention then 1 finger per day ?