Postpartum Fundus and Lochia

After the placenta separates, open vessels remain at the placental site. The uterine muscle normally contracts around these vessels, compressing them and limiting blood loss. A firm fundus is therefore more than a routine finding: it is bedside evidence that the uterus is providing its own haemostatic control. A boggy, soft fundus suggests uterine atony. Poor contraction allows continued bleeding and can progress quickly from visible blood loss to circulatory compromise. A fundus that is higher than expected or displaced laterally may indicate a distended bladder; the bladder can push the uterus upward and interfere with effective contraction. The fundus must never be interpreted alone. Connect its firmness and position with the amount and trend of lochia, vital signs, urine output, skin colour, level of alertness, and the patient’s report of dizziness, weakness, palpitations, or shortness of breath.