After the third stage of labour, a nurse palpates the abdomen of the patient. She should find the uterus in w… - RML 2023

RML 2023

Obstetrics & Gynaecology

Easy

Appeared in: RML 2023

Explanation

Immediately after the delivery of the placenta (third stage of labor), the uterus begins the process of involution, contracting strongly to return to its pre-pregnant state.
A firm, contracted uterus is essential to compress the open blood vessels at the placental implantation site, a mechanism known as 'living ligatures', which prevents postpartum hemorrhage (PPH).
The top of the uterus (fundus) should be palpable as a firm, hard, globular mass at or just below the level of the umbilicus.
This combination of a firm tone and appropriate location indicates normal physiological changes and effective hemostasis.

Option B: A tender uterus is an abnormal finding that suggests a possible infection, such as endometritis. A fundal height above the umbilicus indicates the uterus is displaced, most commonly by a full bladder, which prevents it from contracting properly.
Option C: While the uterus should be firm, its location above the umbilicus is abnormal. This upward displacement is typically caused by a full bladder, which hinders the uterus's ability to contract effectively and stay in the midline.
Option D: A soft, or 'boggy', uterus is the hallmark sign of uterine atony, which is the failure of the uterine muscles to contract. This is a critical and dangerous finding as it is the leading cause of postpartum hemorrhage, a medical emergency.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Postpartum uterine assessment and involution in the correct sequence, documenting the action clearly, and monitoring for the expected response.
Postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide. Accurate and timely assessment of uterine tone and fundal height is the most critical nursing intervention to prevent PPH.
If a boggy uterus is palpated, the immediate nursing action is to perform fundal massage to stimulate contraction while calling for help.
If the uterus is firm but displaced, the nurse should assist the patient to empty her bladder, as a full bladder is the most common cause of displacement and can lead to uterine atony.

How to Approach the Question

First, identify the key clinical timeframe in the question: 'after the third stage of labour'. This is the immediate postpartum period.
Recall the normal physiological process of uterine involution. The primary goal is to achieve hemostasis at the placental site.
Evaluate each option based on two critical parameters: uterine tone (firmness) and uterine location (fundal height).
A normal, safe finding is a FIRM uterus (indicating contraction) located at or BELOW the umbilicus.
Eliminate options describing abnormal findings: 'soft/boggy' (indicates atony/hemorrhage risk), 'above umbilicus' (indicates displacement/impaired contraction), and 'tender' (indicates infection).

Concept Tested & Keywords

QHi2ICU-33eWGpnW_EOLui

E6 Obstetrics Williams p. 35-56

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 51-62