Postpartum Care: Assessing Fundus and Lochia

Introduction

• Presenter: Meris from Level Up RN
• Topic: Assessing a patient's fundus and lochia postpartum
• Resources: Maternity flashcards available at leveluprn.com

Assessing the Fundus

Fundus Overview

• Definition: The topmost portion of the uterus, palpable from outside
• Importance: Assessing location, firmness, and whether it is displaced

Assessing Fundal Height

• Location: In relation to patient's abdomen (umbilicus level, above, below)
• Trend: Expected to trend down over time
• Displacement: Lateral displacement suggests the patient needs to empty bladder
  • Bladder anatomy: Anterior to the uterus, affects uterine positioning
  • Risk: Full bladder can prevent uterine involution, increasing hemorrhage risk

Actions for Lateral Displacement

• Primary: Have the patient empty bladder
• Challenges: Epidural/spinal can cause urination difficulty
• Noninvasive Measures: Running tap water, pouring water over vulva/perineum
  • If unsuccessful: Catheterization to remove urine

Fundal Firmness

• Firm vs. Boggy: Firm is normal; boggy is concerning
• Boggy Fundus Action: Massage fundus using side of hand while supporting uterus suprapubically
  • Purpose: Expel clots and contract uterus

Use of Oxytocin

• Administration: Common postpartum to aid uterine contraction and reduce hemorrhage risk
  • Alternate Method: Encourage breastfeeding to increase natural oxytocin

Fundal Position Timeline

• 12 Hours Post-Delivery: Firm, midline, at level of umbilicus
• Post 12 Hours: Position rises slightly then descends ~1 cm/day
  • Day 2: 2 cm below umbilicus
  • Day 6: Halfway between umbilicus and symphysis pubis
  • 2 Weeks: Uterus should not be palpable
• Terminology: UU, U-1, U+1 (umbilicus level, minus/plus centimeters)

Assessing Lochia

Overview

• Definition: Vaginal discharge post-delivery (affects both C-section and vaginal delivery)
• Surprise Element: High volume and duration for new mothers

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, can last longer

Assessing Lochia Characteristics

• Odor: Malodorous lochia signals possible infection (e.g., endometriosis)
• Duration: Longer than expected rubra (>1 week) is concerning
• COCA: Color, Odor, Consistency, Amount

Amount of Lochia

• Categories: Scant, light, moderate, large, or heavy, excessive
  • Scant: < 5 cm (2 inches) stain on pad
  • Excessive: Saturating pad within 15 minutes
• Assessment Technique: Check front and back of pad (lochia can pool behind)

Cool Chicken Hint

• 2.5 cm: Size of 25 cents for easy recall

Quiz Questions

1. Fundus Deviated to the Right: Empty bladder
2. Boggy Fundus: Massage fundus
3. Fundus at 12 Hours Postpartum: Firm, midline, at level of umbilicus
4. Start of Lochia Alba: 10-14 days post-delivery
5. 9 cm Lochia Stain: How to document

Conclusion

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