From the Guidelines
During a maternal uterine check, healthcare providers should assess uterine size, position, consistency, and tenderness, as well as evaluate uterine tone, and check for abnormal bleeding patterns, as recommended by the most recent and highest quality study 1.
Key Aspects of Uterine Health
The examination typically includes:
- Checking the uterine size, position, consistency, and tenderness through abdominal palpation
- Measuring the fundal height to track fetal growth and uterine expansion
- Evaluating uterine tone to prevent postpartum hemorrhage
- Noting any abnormal bleeding patterns that may indicate complications
- Assessing for uterine tenderness, lochia, or symptoms of inflammation, as well as pelvic floor dysfunction, vaginal discharge or bleeding, and perineal pain 1
Imaging Considerations
In cases where ultrasound is not sufficient, MRI can be considered for the assessment of the endometrium, especially when there are limitations to transvaginal ultrasound (TVUS) due to uterine position, patient body habitus, or presence of uterine pathology 1.
Additional Assessments
Providers should also:
- Listen for fetal heart tones using a Doppler device and assess for contractions, noting their frequency, duration, and intensity
- Check for proper uterine involution and ensure the placenta was completely expelled after delivery
- Assess bowel and urinary function, and check for faecal or urinary incontinence, as well as perineal or anal sphincter injury 1 These assessments help identify potential complications, allowing for timely intervention to protect both maternal and fetal health.
From the Research
Uterine Health Check
To check for uterine health in a maternal check, the following aspects should be considered:
- A comprehensive history and physical examination, including a pelvic examination with speculum and bimanual components 2
- Evaluation of menstrual history to identify any abnormal uterine bleeding (AUB) or heavy menstrual bleeding (HMB) 3, 4, 2
- Use of the PALM-COEIN classification system to determine the underlying cause of AUB 3, 2
- Performance of a pregnancy test and complete blood count (CBC) with platelets 2
- Consideration of medical history and symptoms to determine the need for a pelvic examination 5
Diagnostic Tests
Diagnostic tests that may be used to evaluate uterine health include:
- Pelvic examination to assess the size and location of any uterine fibroids or other abnormalities 6, 5
- Ultrasound to determine the size and location of uterine fibroids or other abnormalities 6
- Transvaginal ultrasound or magnetic resonance imaging (MRI) scan to identify uterine fibroids or other abnormalities 4
Risk Factors
Risk factors that may increase the likelihood of uterine health issues include: