Where should the fundus of the uterus be palpated one week postpartum?

Fundal Height Assessment One Week Postpartum

The fundus of the uterus should be palpated at the level of the symphysis pubis or slightly below one week postpartum. 1

Normal Uterine Involution Process

• The uterus undergoes a predictable pattern of involution during the postpartum period, with the fundus typically descending approximately one fingerbreadth (1 cm) per day 1
• At one week postpartum (day 7), the uterus should have descended to approximately the level of the symphysis pubis or slightly below 1
• This normal involution process represents the gradual return of the uterus to its non-pregnant state 1

Assessment Technique

• To properly assess fundal height, place the patient in a supine position with knees slightly flexed 1
• Begin palpation at the level of the umbilicus and move downward toward the symphysis pubis 1
• Use the ulnar edge of one hand to identify the firm, rounded upper border of the uterus 1
• Apply gentle but firm pressure to accurately determine the position of the fundus 1

Clinical Significance

• Proper assessment of fundal height helps identify potential complications such as:
  • Subinvolution (delayed uterine involution) which may indicate retained products of conception or endometritis 1
  • Postpartum hemorrhage, which may be associated with abnormal fundal height 1
  • Uterine atony, which may be detected through fundal assessment 1

Warning Signs Requiring Further Evaluation

• Fundal height above expected level (higher than symphysis pubis at one week postpartum) may indicate:
  • Retained placental fragments 1
  • Uterine subinvolution 1
  • Postpartum endometritis 1
• Tenderness during fundal palpation may indicate infection or other complications 1

Common Pitfalls in Assessment

• A distended bladder can falsely elevate the apparent fundal height and should be emptied prior to assessment 1
• Increased body mass index may make accurate palpation more challenging 1
• Variability in normal involution patterns exists among women, with some studies showing considerable individual differences in the rate of involution 2
• Relying solely on fundal height measurement without considering other clinical signs may lead to missed diagnoses 2

Documentation

• Document the location of the fundus in relation to anatomical landmarks (symphysis pubis, umbilicus) 1
• Note any tenderness, firmness, or other abnormal findings during palpation 1
• Compare with expected involution pattern to identify potential deviations 1