Postpartum Care: Assessing Fundus and Lochia

Assessing the Fundus

• Fundus Definition: The topmost portion of the uterus, palpable from the outside.
• Assessment:
  • Feel its position in relation to the abdomen (e.g., at, above, or below the umbilicus).
  • Monitor its movement or trend (descending or ascending).
  • A displaced fundus laterally indicates a need for the patient to empty their bladder, as a full bladder can prevent the uterus from being midline.
• Risks:
  • A laterally displaced fundus due to an overfull bladder can risk postpartum hemorrhage.
• Patient Management:
  • If the fundus is deviated, have the patient empty their bladder.
  • Non-invasive measures to aid urination include:
    • Running tap water
    • Pouring water over the vulva and perineum
  • Catheterization is a last resort due to infection risk.

Fundus Consistency

• Firm Fundus: Desired state.
• Boggy Fundus: Indicates uterine atony, risking postpartum hemorrhage.
  • Nursing Action: Massage the fundus to firm it up and expel clots.
  • Oxytocin administration is common to encourage uterine contraction.
  • Encourage breastfeeding for natural oxytocin release.

Positioning

• 12 hours post-delivery:
  • Should be firm, midline, and at the level of the umbilicus.
• Movement Over Time:
  • Can ascend by 1 cm before descending.
  • Descends by 1 cm daily postpartum.
  • By day 6, it should be halfway between umbilicus and symphysis pubis.
  • Not palpable by two weeks postpartum.
• Terminology:
  • “UU”, “U-1”, “U+1” indicate position relative to umbilicus, measured in finger breadths (1 cm).

Assessing Lochia

• Lochia Definition: Vaginal discharge post-delivery.
• Types of Lochia:
  • Lochia Rubra: Dark red, 1-4 days post-delivery.
  • Lochia Serosa: Pinkish-brown, 4-9 days post-delivery.
  • Lochia Alba: Creamy white, 10-14 days or up to months post-delivery.
• Concerns:
  • Malodorous lochia indicates possible infection.
  • Prolonged lochia rubra (>7 days) is abnormal.

Lochia Assessment

• Criteria: Color, odor, consistency, and amount.
• Amount Categories:
  • Scant (<5 cm or 2 inches on pad)
  • Excessive (saturation of a pad within 15 minutes)
• Assessment Technique:
  • Examine both front and back of the pad due to potential pooling behind the buttocks.
• Memory Aid: "Cool chicken" hint – 2.5 cm is the size of a quarter.

Quiz Questions

1. What is the priority action if the fundus is deviated to the right?
2. What should be done if the fundus is boggy?
3. Where should the fundus be located 12 hours postpartum?
4. When does lochia alba begin?
5. How should a 9 cm stain of lochia be documented?

Conclusion

• Encouragement to review and test knowledge using provided questions.
• Suggestion to subscribe and share the channel with fellow nursing students.