A nurse cares for a postpartum patient 12 hours after birth. Which finding requires further assessment?

• A. Lochia moderate amount
• B. Fundus two fingerbreadths above the umbilicus
• C. Fundus firm
• D. Perineum with intact episiotomy

Answer: (B)

After delivery, the uterus should contract and descend, so its location and firmness reflect involution and the risk for postpartum hemorrhage. At about 12 hours after birth, the uterus should be at or near the level of the umbilicus and feel firm. A fundus that is two fingerbreadths above the umbilicus signals that the uterus is not in the expected position and may be boggy or displaced, often from a full bladder or uterine atony. This is the finding that needs prompt assessment because it raises concern for inadequate uterine contraction and potential excessive bleeding.

If the fundus is high and/or boggy, first assess for and relieve a full bladder by helping the patient empty her bladder, then perform fundal massage to stimulate contraction while monitoring the lochia and vital signs. Confirm that the uterus becomes firm and descends toward the umbilicus with continued observation. The other findings—lochial flow that is moderate, a firm fundus, and an intact episiotomy—are expected and require routine monitoring rather than immediate intervention.