Where is the Uterine Fundus palpable at 20 weeks of pregnancy?

MP CHO -2021 (Shift 1st)

Obstetrics & Gynaecology

Easy

Appeared in: MP CHO -2021 (Shift 1st)

Explanation

At 20 weeks of gestation, the growing uterus reaches the level of the umbilicus.
This is a standard anatomical landmark used in antenatal care to assess if fetal growth is on track.
The fundus can be palpated at the lower border of the navel at this stage.
The provided image visually confirms this landmark, showing the top of the uterus at the umbilicus at the 20-week mark.

Option A: While the fundus is in the abdomen, this answer is too general and not clinically specific. Antenatal assessment requires precise anatomical landmarks.
Option C: The fundus is palpable just below the xiphisternum at a later stage of pregnancy, typically around 32-34 weeks.
Option D: The fundus reaches its highest point, at the level of the xiphisternum, at approximately 36 weeks of gestation.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Assessment of fundal height during pregnancy as background academic context rather than a clinical decision trigger.
Measuring fundal height is a fundamental, non-invasive nursing skill used during every antenatal visit to monitor fetal growth and well-being.
A significant discrepancy between the measured fundal height and the expected height for gestational age can be an early indicator of problems such as intrauterine growth restriction (IUGR), polyhydramnios (excess amniotic fluid), or multiple gestation.
What if? If at 20 weeks the fundal height measures significantly lower (e.g., at the 16-week level), the nurse should suspect potential IUGR, oligohydramnios, or an error in dating the pregnancy, and the patient should be referred for an ultrasound for further evaluation.

How to Approach the Question

This is a factual recall question common in obstetrics.
First, identify the key information required: the location of the uterine fundus at a specific gestational age (20 weeks).
Recall the standard anatomical landmarks for fundal height progression during pregnancy.
Mentally visualize or sketch the progression: Symphysis pubis (12 weeks) -> Midway to umbilicus (16 weeks) -> Umbilicus (20 weeks) -> Xiphisternum (36 weeks).
Compare the options to these known landmarks. 'Lower border of the umbilicus' is the most accurate description for 20 weeks.
Eliminate the other options based on their corresponding gestational ages: 'Just below the xiphisternum' (approx. 32-34 weeks) and 'At the level of the xiphisternum' (approx. 36 weeks).

Concept Tested & Keywords

Concept Tested: Assessment of fundal height during pregnancy.
Stem keywords: Uterine Fundus, palpable, 20 weeks, pregnancy
Lead-in keywords: Where is
Clinical cues: Gestational age of 20 weeks is a key clinical marker for fundal height assessment.

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E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 15-23

E6 Comprehensive Textbook of Community Health Nursing for BSc Nursing Students Part 2 — Subpart A (pp 1-275 of 550) p. 199-201