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[help] Confusion about fundal massage

Hi there,

I wish I could say I retained more from my OB classes/rotation in nursing school (just a year ago) but I'm a bit rusty. I might be getting a PP job soon so I've been trying to polish up some of my theory.

I was rereading my OB textbook and reviewing fundal palpation and massage.

I need some help understanding something here.

If the fundus is boggy, they say to gently but firmly massage the fundus in a circular motion. They also say that a boggy fundus may be r/t accumulated clots which should be expressed. I was then reading that one isn't suppose to express clots until the uterus is firmly contracted. wait, what? You're supposed to help the uterus firm up but how is going to if you can't express them? I am SO CONFUSED. I am either totally reading this wrongly or the book is not articulating itself well.

Oh, and another thing: I was reading that you aren't to "push" on an uncontracted uterus--aren't you somewhat "pushing" on the uterus anyway when you are palpating it and then massaging it or does this mean like blatant pushing? And if yes, is it pushing/pressing down on the fundus down towards the direction of the vagina? I don't remember ever learning about this in nursing school.

Anyhow, Can I kindly ask for some helpful comments here? I'd really really appreciate it. I've been making a concerted effort to really try to understand these things but the above just throws me off. THanks so much.

Well I am majorly new to PP, but here is what i have learned so far.... it takes very little circular motion to make a fundus firm (as a rule anyway) yes you do have to push down to check the fundus for firmness and if they are real boggy blood can gush out. But for some people the fundus is just an inch from the surface others you have to dig deep to find, so their can be some "pushing." I don't know about expressing clots. Maybe someone else can answer that. But I can understand that it would not be wise to express clots without the fundus being firm, you are just going to have a pt. bleeding more and producing more clots. So I check the fundus for firmness, if it is firm great, watch to see if blood spurts out when I push. If it is boggy massage till firm which is usually very quick, and the pts. can feel the cramping. I know that sometimes a pt. will not stop bleeding and a drug is given- methergine or pictocin is given in a iv bag sometimes, I have not had to use it. Anyway that is my small amount of knowledge, I am sure an experienced nurse can give you more detailed info-- good luck!!

Thanks for the comment, Mirasol. What you said makes sense and yes, I'll have to investigate further the issue of expressing clots.

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