Fundus

Definition

The fundus is the dome-shaped top of the uterus, opposite the cervix. Postpartum fundal assessment is critical to evaluate uterine involution and identify hemorrhage risk.

Normal Postpartum Fundal Findings

• Immediately after delivery: at umbilicus
• 12 hours post: 1 cm above umbilicus
• Descends 1 cm (1 fingerbreadth) per day
• By day 10: no longer palpable (below symphysis pubis)
• Should be firm and midline

Abnormal Findings

• Boggy: Uterine atony. Leading cause of postpartum hemorrhage. Massage fundus first; administer oxytocin.
• Deviated right: Full bladder (encourage voiding).
• High: Retained placenta, bladder distention, or clots.

Technique

Have patient void before assessment. Place one hand above symphysis to support lower uterus; palpate fundus with the other hand. Measure in fingerbreadths above/below umbilicus.

NCLEX Relevance

Boggy fundus → massage first; then administer oxytocin.