Fundus palping

[nurse/midwifekim]

Hi Everyone,

Are you palping or not palping the fundus in your routine postnatal check?? I was never taught to, but not encouraged not too.... I usually check it if i'm concerned about the amount of lochia.... but i'm starting to rethink this after a c-sec patient had a PPH on the ward....

I would appreciate your thoughts thanks (and where your from too)

love kim

[LoveMyBugs, BSN, CNA, RN]

I am just a student, and not working on an OB unit, but in our OB rotation our instructor told us to always palpate the fundus as part of the assessment, she stressed always, always, always, how would you know if it is firm or boggy, is it displaced and she needs to urinate.

[rebstudent]

Hi there. I am just a student too, from NZ, and we are studying maternity health right now. We were told to palpate the fundus in all postnatal assessments

[krenee]

Always! If I do nothing else, I check the fundus and the lochia! I'm surprised that it's not emphasized at all hospitals. PPH is the most common complication postpartum.

Kelly

[heatheryk]

Always palpate the fundus. Also be careful w/ mom's post c/s, particularly if they were sectioned before labor or in early labor. The cervix in these patients are not open. They can get clots stuck in the uterus, uterus can't contract, that will cause a bleed. So massage often in these patients.

[sahm02]

Curious as to why you would not be encouraged too. PPH is of the highest concern after both a lady partsl and cesarean. Amt, color and odor are all something that should be assessed and documented. It is not the most fun part of our job and the pt's don't enjoy it at all, but the most important.

[meteorite36]

This is standard protocol for both midwives and labour and delivery nurses. Palpating the fundus also allows you to assess the bladder, which, if full, may precipitate excessive blood loss. A full bladder will cause the fundus to palpate higher than would normally be expected, and also may cause deviation to the right or left. Remember to check the patient's obstetric history also, as fibroids can give an erroneous reading.

[klone, MSN, RN]

Yes, always. I'm very *firm* with my palpation in the immediate postpartum period (first few hours - but even then, I only dig REALLY hard if bleeding is heavy or I'm expressing clots). After that, if bleeding has been WNL, then I generally palpate for position only.

Does your charting not have a place to enter "fundal position/height"?

[meteorite36]

Yes, we have computer charting which does both height and position. The charting is efficient but very time consuming!

[flightnursetaylor]

I agree with the palpating. If your computer prompts you for position and height, you cannot legally chart in those spaces until you have done a palpation. So many postpartums can have trouble with a boggy uterus but no one knows until they have bled out and passed out and then it is a rush to try and get that uterus firm again. By then she has lost a lot of blood and could have been avoided had her nurse assessed that fundus often.

[Elvish, BSN, DNP, RN, NP]

I always check a fundus & lochia, whether c/s or lady partsl. That's a pretty easy thing to do, and it can save you a lot of trouble later if you catch problems early.

[BabyLady, BSN, RN]

Palpating the fundus is absolutely necessary, a minimum of once per shift.

I can tell you from personal experience, that documenting changes is important.

I once had a post-partum patient whose fundus was going UP, not down.

It turned out there was a blockage of a huge clot over her cervix that was inhibiting blood flow...it required a physician to remove it.

Had I not checked her fundus, I never would have known.

Yes, it's uncomfortable, but necessary.

I also remind post-partum patients to be sure to call the nurse IMMEDIATELY if they have a headache or leg cramps and not to wait until someone comes back into the room.

Many do not realize that they are at risk for preeclampsia up to 6 weeks PP.