Assessment of the Fundus in Relation to Umbilicus and Symphysis Pubis

How do assess the fundus before birth/during pregnancy

Measure the fundus Height

What does the fundal height tell us?

Assess the growth of the baby

Helps to determine gestational age

How do you measure the fundal height?

Measure from the symphysis pubis to the fundus

Normal Measurement of fundal height

Should match the gestational age after 20 weeks, +/- 2 cm

• Example

  • 28 weeks, 28 cm

    • 26-30 cm would be normal

Where should the fundus be at 12 weeks?

At/Above the symphysis pubis

Where should the fundus be at 12-20 weeks (16 weeks)

In between symphysis pubis & belly button

Where should the fundus be at 20 weeks

should be at belly button

Where should the fundus be 20-36 weeks

Reflect weeks pregnant +/- 2 cm

Where should the fundus be at 36 weeks

At xiphoid process (highest point)

Where should the fundus be at 37-40 weeks?

Moves down about 4 cm in preparation for birth

Lightening

Where should the fundus be immediately after birth

Midline, midway between umbilicus and symphysis pubis

Where should the fundus be 1 hour after birth, remains for 24 hours

at the level of the umbilicus

at U

Where should the fundus be 12 hours after birth?

1 cm above umbilicus

U + 1

Location of fundus 24 hours postpartum

1 cm below umbilicus

U - 1

How should the fundus decent following birth?

Descends one fingerbreadth (1cm) per day

Location of fundus 7 days after birth

Back at symphysis pubis

Location of fundus 10 days after birth

Not palpable

How often should the fundus, lochia, and perineum be assessed postpartum?

q 15 mins

Normal fundus assessment

Firm and midline

Concerning fundus assessment

Boggy = non contracted, increased risk for bleeding