Uterine Fundal

Fundal assessment follows uterine involution: after the placenta is delivered, the myometrium contracts and compresses the open vessels at the placental site. The contracting muscle acts like a set of living ligatures. A firm uterus closes those vessels; a relaxed uterus cannot, so bleeding can become rapid. Soon after birth, the fundus should feel firm and sit near the umbilical level, with a central position. By 24–48 hours postpartum, the expected fundal height is at the umbilicus, followed by regular downward descent as involution continues. The exact finding must be interpreted with the amount of lochia, the patient’s vital signs, symptoms, and bladder status. A fundal height that appears acceptable does not rule out serious bleeding. An RPN performs and documents this assessment within personal competence, employer policy, and applicable provincial scope requirements. An abnormal finding is communicated through the local escalation pathway, which may include the RN, midwife, nurse practitioner, physician, or the postpartum hemorrhage response team.