Uterine involution is the natural process by which the uterus returns to its pre-pregnancy size, shape, and position following childbirth. It begins immediately after the delivery of the placenta and typically completes within 6 weeks postpartum
Definition
Assessing the state of uterus in the postdelivery period as it returns to the pregravid state.
Purposes for measuring Uterine involution
- To rule out infection.
- To estimate the rate at which involution takes place.
- To assess the puerperal condition of women who had complicated labor.
Stages of Uterine Involution
| Time Postpartum | Uterine Changes |
|---|---|
| Immediately after birth | Fundus at or below umbilicus; weighs ~1000g |
| 1 week | Fundus descends ~1 cm/day; uterus ~500g |
| 2 weeks | No longer palpable abdominally |
| 6 weeks | Returns to pre-pregnancy size (~60g) and pelvic position |
Equipment’s
- Screen.
- Inch tape.
- Clean gloves.
Procedure for Measuring Uterine Involution
| Nursing action | Rationale | |
| 1. | Before procedure Explain the procedure to patient and instruct her on how she has to cooperate. | Enhances cooperation. |
| 2. | Arrange the unit and assemble necessary articles at bedside. | Saves time and energy. |
| 3. | Ensure that patient’s bladder is empty. | Full bladder may cause upward displacement of uterus. |
| 4. | Pull curtains/screen the bed. | Provides privacy. |
| 5. | Position the patient in supine and drape the patient exposing only the lower abdomen. | Enhances easy assessment. |
| 6. | During procedure Don gloves. | Protects hands from contamination. |
| 7. | Locate fundus with the palm of one hand. | Helps ascertain the level of fundus. |
| 8. | Place lateral side of hands slightly above fundus. | Stabilizes the uterus. |
| 9. | Place your other hand above the symphysis pubis. | Supports and stabilizes the uterus during palpation. |
| 10. | Gently but firmly press into abdomen toward the spine and then slightly downward toward the perineum until a mass is felt in the palm of the hand. | Locates the uterine mass. |
| 11. | Measure the number of finger breadth at which the fundus is felt below the umbilicus. With the help of an inch-tape measure from the level of fundus to the upper border of symphysis pubis. | Finger breadth measurement should correspond to the number of days after delivery, On Ist postpartum day, the fundus is felt about 10-12 cm above the symphysis pubis and from 2nd-11th day fundus descends at a rate of half inch/one finger breadth (1.25 cm) per 24 hours. By 11th day, uterus sinks below the level of symphysis pubis and becomes a pelvic organ. |
| 12. | After procedure With gloved hand, check perineal pad for color of lochia. | Allows for assessment of rate of involution. |
| 13. | Offer perineal care if needed and provide a clean pad. | Maintains hygiene and prevents infection. |
| 14. | Replace the articles and wash hands. | Prevents spread of microorganisms. |
| 15. | Mark the fundal height in nurse’s record. | Documentation helps in obtaining a clear picture about involution of uterus. |
Nursing Care Considerations
- Fundal assessment: Palpate fundus regularly for firmness and position
- Lochia monitoring: Note color, amount, odor, and progression
- Pain management: Address afterpains with NSAIDs or warm compresses
- Patient education:
- Encourage breastfeeding and ambulation
- Teach signs of abnormal involution (e.g., heavy bleeding, foul discharge, fever)
- Emphasize hygiene and perineal care
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Annamma Jacob, Manual of Midwifery and Gynaecological Nursing, 4th Edition, 2023, Jaypee Publishers, ISBN: 978-9356961593
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