02.04 Fundal Height

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Overview

  1. Fundus definition:  the top of the uterus, palpable
  2. Used to measure the gestation based on height of Uterus
  3. Closely observed after delivery to ensure adequate postpartum recovery ie: uterus isn’t filling up too much with blood causing it to be “boggy” or up higher and that it is contracting back to prepregnancy state

Nursing Points

General

  1. Fundal Height
    1. Measured externally in pregnancy in centimeters and should equal the gestational age
      1. Ie: 28 cm should be 28 weeks pregnant
    2. Measured post pregnancy during the postpartum recovery in “fingerbreadths” or centimeters
      1. U = its at the umbilicus
      2. U-1, U-2, U-3=it is 1,2,or 3 cm below the umbilicus
      3. U+1,U+2= it is 1, or 2 cm above the umbilicus
  2. Purpose
    1. The fundal height helps the provider to evaluate the age of the fetus
    2. During the 1st and 2nd trimesters, it is approximately equal to gestational age in weeks (+/- 2 centimeters)
    3. The fundal height in the postpartum period help to ensure the uterus is contracting properly

Assessment

  1. For fundal height measurement during pregnancy
    1. Have the patient lie back (not flat→ can cause a decrease in BP, called supine hypotension )
    2. Measure beginning at the symphysis pubis and go to the top of the uterus
    3. Measurement is in centimeters
  2. For fundal height measurement in the postpartum period
    1. Make sure patient has voided recently
    2. Have the patient lie flat on her back
    3. Palpate at the top of the uterus while the other hand is at the base of the uterus
    4. Feel the fundus and measure how far below or above the umbilicus it is (U)
    5. Measurements in centimeters or fingerbreadth

Therapeutic Management

  1. Fundal height measuring bigger than gestation could be fetus is large for gestational age or there is polyhydramnios
  2. Measuring small may indicate possible issues with fetal development
  3. If in the postpartum recovery period the fundus is too high or not midline→ empty bladder and reassess

Nursing Concepts

  1. Reproduction
  2. Human Development

Patient Education

  1. Education on the importance of emptying the bladder to ensure the uterus can contract adequately back down to pre pregnancy state and to prevent heavy bleeding.
  2. Explanation on why the fundal measurements are being taken during pregnancy

Reference Links

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Video Transcript

In this lesson I’m going to better explain fundal height to you and what it means in different situations.

We really need to know what the fundus is. The fundus is going to be the top of the uterus and it’s palpable or something we feel and assess for the patient. During pregnancy it’s used to measure the gestational age of the fetus so a measurement is taken. In the postpartum time frame is closely observed and palpated to ensure that the patient is recovering adequately we want to make sure that uterus isn’t filling up too much with blood causing it to be what we called boggy or that it’s not too high up in the uterus meaning it’s too full or the bladder needs to be emptied so we need it to contract back down to the pre-pregnancy state.

The fundus has to be frequently assessed, During pregnancy we will have the patient lie back but not flat. We don’t want her to be flat on her back because of supine hypotensive syndrome that can happen from the weight of the growing uterus on the veins and vena cava so blood return to the brain doesn’t happen as it should. With a tape measure we measure from the pubic symphysis to the funds. It is a measurement taken in centimeters. If the patient is 28 weeks we would expect her to measure 28 cm from the symphysis to fundus. In the postpartum period we need to make sure she has recently voided or that her bladder is empty. This is to prevent the bladder from pushing the uterus up and out of place. A full bladder can make the uterus angry and bleed. Now she can be flat on back because the baby has been born. So she is flat on her back and we palpate the fundus. Now it is very important that you always have one hand at the base of the uterus that way when you palpate and push on the top of the fundus you don’t cause the uterus to come through the vagina. So for this measurement we’re measuring by fingerbreadth and what that means is one finger is equal to about 1 centimeter. You count the number of fingers below umbilicus or above umbilicus. For example a patients fundus is 1 finger below umbilicus you would call that you minus one.
Let’s compare the fundal height difference between when someone is pregnant and then the postpartum period. During pregnancy the fundus is going to be moving up because the baby is getting bigger the uterus is getting larger and it’s moving up in that abdomen. when the patient is postpartum the fundus should be moving down. this is when the uterus is trying to move back down into its cavity.

Let’s look at the timeline of the fundus after delivery. So immediately post delivery this patient’s uterus should be felt at U, which means umbilicus or slightly above. it will slowly move down after that.

Now we are 24 hours postpartum. When we hit 24 hours postpartum the fundus should be palpated at U-1. the uterus should contract down one finger breadth every 24 hours. this is a guideline different situations are going to obviously cause different occurrences but this is the rule. Usually this will be a test question. if in the question the patient is only 10 to 12 hours postpartum they’re going to be U to U+1 maybe 2. when they hit 24 hours they should be -1.

Now this patient is 48 Hours postpartum. Where would we expect to find the fundus? we would expect to find it at U-2.

Now I wanted to make sure you were aware that this uterus is not going to keep being felt all the way to the 6-week postpartum recovery. Eventually that uterus has to reach a point where it’s deep into its cavity and we cannot feel it. this point is going to be in about 2 weeks. this is another good test question. so we would not expect to feel a patient’s uterus after 2 weeks postpartum.

Our therapeutic management for this patient is going to be to make sure she’s comfortable. we need her in a comfortable position before we start our assessment piece. We also need to ensure that she has emptied her bladder. to review if you remember that full bladder is going to one cause discomfort as were pushing on her uterus and also in the postpartum time frame it will cause the uterus to measure higher or off to the side so first it will not give us an accurate measurement and also could cause her bleeding to be more heavy. remember of full bladder makes the uterus angry. The last piece understand that could change our management for this patient is what happens if the measurement doesn’t match up? If the uterus measures 28 cm and the patient is really supposed to be 30 weeks the the baby is measuring 2 weeks too small and vice versa. this could just require some extra appointments or ultrasounds to make sure that the baby is doing okay in utero.
Education for this patient should include why we are checking this uterine measurement during pregnancy. This way she knows exactly what we’re measuring for. When the patient is postpartum good education is why we check it and what we’re looking for. The pushing on the fundus and checking location is not the most comfortable for the patient so if they have an understanding as to why we’re checking it it will help.You can also let the patient you’ll what it feels like when it’s contracted so think of an orange we should be feeling kind of an orange as if you’re pushing on an orange and that’s called firm. That’s what we want to feel. if it feels more smooshy a foam ball this is called boggy. This is a uterus that is not contracting correctly and could be starting to bleed too much. This is a uterus that needs to be rubbed on to make the muscles contracts.

Our nursing concepts are reproduction because the patient is or was pregnant and human development because the size of the fundus has to do with how well development of the fetus is going.
Are key points to remember is that the fundus is the top of the uterus and it’s palpable we wanted to feel firm. Boggy means bleeding and needs interventions. To obtain the gestational measurement you measure from the pubis symphysis to the fundus in centimeters. And then just remember we describe this as either firm or boggy. Firm is good boggy means not contracted and bleeding you can remember that as B&B.

Make sure you check out the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing.

Read more

  • Question 1 of 6

The nurse is assessing a postpartum client who has just delivered less than an hour ago. Where would the nurse expect to find the fundus of the uterus?

  • Question 2 of 6

A nurse is assessing a client’s fundal height. The client has just started her third trimester of pregnancy. When positioning the client for this assessment, what complication should the nurse monitor for?

  • Question 3 of 6

A nurse is assessing a client who is 2 days postpartum. What should the nurse expect when assessing fundal height?

  • Question 4 of 6

During the postpartum period, by what time frame should the uterus no longer be palpable?

  • Question 5 of 6

An antepartum client wants to know if she is measuring too big during an antenatal exam. The client is 32 weeks’ gestation. Which measurement from the symphysis to the top of the uterus represents a uterine measurement that is too big for 32 weeks’ gestation?

  • Question 6 of 6

A nurse is assessing a 30-week pregnant client at her OB appointment. What should the nurse expect when assessing fundal height?

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