In the immediate postpartum period, which fundal finding indicates uterine atony requiring fundal massage?

• A. Boggy uterus, usually palpable above the umbilicus, with heavy lochia.
• B. A firm uterus at the level of the umbilicus with light lochia.
• C. A boggy uterus below the pubic symphysis with scant lochia.
• D. A firm uterus with no lochia.

Answer: (A)

A boggy uterus that’s palpable above the umbilicus with heavy lochia signals uterine atony. After delivery the uterus should be firm and located at the level of the umbilicus or slightly below, contracting to compress blood vessels and control bleeding. When the fundus is soft (boggy) and higher than expected, it means the uterus isn’t contracting effectively, allowing ongoing bleeding and a high risk for hemorrhage. The immediate intervention is fundal massage to stimulate contraction and restore tone, along with ensuring the bladder is empty and monitoring for ongoing bleeding.

Normal findings to contrast with this include a firm fundus at or near the umbilicus with light lochia, which is expected postpartum and does not require massage. A boggy fundus that’s very low (below the pubic symphysis) with scant lochia is not the typical atony pattern, and a firm fundus with no lochia does not align with the usual postpartum involution scenario.