Which observation would indicate a normal involution postpartum?

• A. Boggy fundus 1 cm below the umbilicus
• B. Firm fundus at or near the umbilicus
• C. Fundus not palpable
• D. Fundus displaced to the right of midline

Answer: (B)

Postpartum involution is the process of the uterus returning to its pre-pregnant size after birth. A normal finding is a firm fundus that remains midline and is at or near the level of the umbilicus during the first 24 hours, and then descends about 1 cm per day as it continues to involute. A firm fundus indicates good uterine tone and effective contraction, which helps compress uterine vessels to prevent hemorrhage. The observation described as a firm fundus at or near the umbilicus fits this pattern and is the best indicator of normal involution. In contrast, a boggy fundus below the umbilicus signals uterine atony and a risk of heavier bleeding; a fundus not palpable suggests potential severe atony or retained placental tissue; and a fundus displaced to the right usually points to a full bladder pushing the uterus off-center, which can interfere with involution but is not a normal finding on its own.