Postpartum Care: Assessing Fundus and Lochia

Introduction

• Presenter: Meris from Level Up RN.
• Focus: Assessing patient's fundus and lochia during postpartum care.
• Reference Material: Maternity flashcards available at leveluprn.com.

Assessing the Fundus

• Definition:
  • The fundus is the topmost portion of the uterus.
  • Can be palpated from the outside for assessment.
• Assessment Points:
  • Fundal height: Check where it is in relation to the abdomen (e.g., at the umbilicus, above, or below).
  • Trend observation: Is the fundus descending normally post-delivery?
  • A laterally displaced fundus indicates a full bladder, potentially preventing proper uterine contraction and increasing the risk of postpartum hemorrhage.

Actions for Displaced Fundus

• Have patient empty bladder.
• Difficulty urinating may occur, especially after epidural or spinal anesthesia.
• Non-invasive measures to assist urination:
  • Running tap water.
  • Pouring water over vulva and perineum.
• If unsuccessful, catheterization may be needed but should be a last resort due to infection risk.

Fundus Consistency

• Firm Fundus:
  • Desired state indicating proper contraction.
• Boggy Fundus:
  • Indicates poor contraction.
  • Immediate action: Massage the fundus using the side of the hand, with the non-dominant hand providing suprapubic pressure.
  • Administer oxytocin as ordered (helps contract uterus and reduce hemorrhage risk).
  • Encourage breastfeeding to naturally increase oxytocin levels.

Fundus Position Postpartum

• 12 Hours After Delivery:
  • Should be firm, midline, and at the umbilicus.
• Descension Pattern:
  • Rises slightly before descending.
  • Descends approximately 1 cm per day.
  • By day 6, halfway between umbilicus and symphysis pubis.
  • By two weeks, should not be palpable.
• Notation:
  • "U" (umbilicus level), "U-1," "U+1" (measured in finger breadths, ~1 cm).

Assessing Lochia

• Definition:
  • Vaginal discharge post-delivery, present in both C-sections and vaginal births.
• 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 up to months.

Important Considerations

• Malodorous Lochia:
  • Indicates possible infection.
• Extended Lochia Rubra (>1 week):
  • Report to provider.

Assessment Parameters

• Color, Odor, Consistency, Amount:
  • Amount:
    • Scant, light, moderate, large, excessive.
    • Scant: <5 cm stain.
    • Excessive: Saturation of pad in 15 minutes.
  • Check both front and back of pad due to pooling effects.

Cool Chicken Tip

• 2.5 cm is equivalent to the size of 25 cents (two quarters).

Quiz Questions

1. Fundus deviated right: Priority action? (Empty bladder)
2. Boggy fundus: Priority action? (Massage fundus)
3. 12 hours postpartum fundus location? (At umbilicus)
4. Lochia alba onset? (10-14 days post-delivery)
5. Documentation for a 9 cm lochia stain? (Use nursing judgment for categorization)

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