Postpartum Care: Assessing Fundus and Lochia

Introduction

Definition: The fundus is the topmost portion of the uterus, palpable externally.
Assessment:
- Fundal Height: Determine its position relative to the umbilicus (above, below, or at level).
- Lateral Displacement: Indicates a full bladder, as the bladder is anterior to the uterus.
  - Action: Have the patient empty their bladder to prevent postpartum hemorrhage.
  - Difficulty Urinating: Common with epidural or spinal anesthesia.
    - Non-Invasive Measures:
      - Running tap water
      - Pouring water over vulva and perineum
    - Invasive Measure: Catheterization if non-invasive measures fail.
Fundus Texture:
- Firm: Preferred condition to prevent hemorrhage.
- Boggy: Indicates poor contraction, risk for hemorrhage.
  - Action: Massage the fundus with the side of the hand, using the non-dominant hand to support above the pubic area.
Oxytocin Use:
- Administer as ordered post-delivery to aid uterine contraction.
- Encourage breastfeeding for natural oxytocin production.
Expected Fundus Position:
- 12 hours postpartum: Firm, midline, at the level of the umbilicus.
- Descends approximately 1 cm per day postpartum.
- 2 weeks postpartum: Uterus should not be palpable.

Definition: Discharge from the vagina after delivery, occurring after both C-section and vaginal births.
Types of Lochia:
- Lochia Rubra: Dark red, lasts 1-4 days post-delivery.
- Lochia Serosa: Pinkish-brown, lasts 4-9 days post-delivery.
- Lochia Alba: Creamy white, lasts 10-14 days, can extend to months.
Abnormal Findings:
- Malodorous Lochia: Indicates possible infection.
- Prolonged Lochia Rubra: Lasting more than a week is a concern.
Assessing Lochia:
- Consider color, odor, consistency, and amount.
- Amount Categories: Scant, light, moderate, large, or excessive.
- Scant: Less than 5 cm (2 inches) stain.
- Excessive: Saturates pad within 15 minutes.
- Assessment Tip: Check both front and back of the pad due to gravity pooling effects.