What would the nurse expect to find when assessing the fundus of the uterus immediately after birth?

Fundal height NCLEX practice questions for nursing students. This quiz will test your knowledge on how to interpret fundal height measurements and location.

This quiz is part of a NCLEX review series over maternity nursing, so be sure to check out those other reviews as well.

Don’t forget to watch the lecture on fundal height before taking this quiz.

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1. Your patient is 48 hours post-delivery. While assessing fundal height, you would expect the fundal height to be?

A. 1 cm above the umbilicus

B. 2 cm above the umbilicus

C. 1 cm below the umbilicus

D. 2 cm below the umbilicus

The answer is D. The fundal height will decrease by 1 cm per day below the umbilicus. Therefore, if the woman is 48 hours postpartum (2 days) the fundal height will be 2 cm BELOW the umbilicus.

2. You’re providing discharge teaching to a new mother who is going home after a vaginal delivery. The woman asks when the uterus will return to its pre-pregnancy size. Your response is?

A. At about 14 days

B. At about 6 months

C. At about 6 weeks

D. At about 7 days

The answer is C. The uterus will return to its pre-pregnancy state at about 6 weeks.

3. During a prenatal visit, you are assessing the fundal height. You find the fundus of the uterus to be right above the symphysis pubis. Based on this finding the patient is about how far along in her pregnancy?

A. 20 weeks

B. 12 weeks

C. 16 weeks

D. 24 weeks

The answer is B. At about 12 weeks of pregnancy, the fundal height can be found right above the symphysis pubis.

4. You’re assessing a patient’s chart and find that the patient is 36 weeks pregnant. Where should you find the fundus of the uterus during your assessment of fundal height?

A. midway between the umbilicus and xiphoid process

B. about 4 cm below the xiphoid process

C. at the xiphoid process

D. 5 cm above the umbilicus

The answer is C. At 36 weeks of pregnancy, the fundal height should be at the xiphoid process.

5. Your patient is 24 weeks pregnant, and you’re measuring the fundal height. Which finding below is a normal measurement for this patient?

A. 16 cm

B. 28 cm

C. 26 cm

D. 12 cm

The answer is C. The patient should be + or – 2 cm of their week of pregnancy. Remember that after 20 weeks of pregnancy the number of weeks the patient is pregnant will match the fundal height measurement plus or minus 2 cm. Therefore, if the patient is 24 weeks, a normal measurement would be either 22 cm to 26 cm.

6. A nursing student, who you are precepting during their OB rotation, asks you when the fundus of the uterus is no longer palpable. You answer:

A. at about 10 to 14 days

B. at about 7 days

C. at 6 weeks

D. 48 hours after the delivery of the baby.

The answer is A. This is when the uterus has entered back into the pelvic cavity and is no longer palpable.

7. A patient is 40 weeks pregnant, and you find the fundal height to be 4 cm below the xiphoid process. Your next nursing action is to:

A. Notify the MD immediately

B. Chart this as a normal finding

C. Place the patient on continuous fetal monitoring

D. Assess the baby’s heart rate with a Doppler

The answer is B. This is a normal finding. After 36 weeks of pregnancy, the fundal height will regress. Remember at 36 weeks the fundus will be at the xiphoid process. However, the fundus of the uterus will decrease about 4 cm from the xiphoid process at about 37-40 weeks of pregnancy. WHY? The baby has settled down into the pelvic cavity and preparing for delivery.

8. Which finding while measuring the fundal height of a patient who is 36 weeks pregnant would require immediate action?

A. The fundal height measures at 38 cm.

B. The patient complains of feeling lightheaded and dizzy.

C. The fundus of the uterus is at the xiphoid process.

D. The patient states she cannot sleep at night.

The answer is B. As the nurse, you must monitor the patient for supine hypotension while measuring the fundal height. This is because as the uterus enlarges it can compress the great vessel of the heart leading to supine hypotension. Therefore, if the patient complains of this during the measurement  you would want to immediately place her on the left side.

9. One hour after delivery where do you expect to find the fundus of the uterus?

A. 4 cm below the xiphoid process

B. right above the symphysis pubis

C. At the umbilicus

D. 2 cm below the umbilicus

The answer is C.

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Fundal height is the distance between your pubic bone and the top of your uterus during pregnancy. Measuring fundal height helps healthcare providers assess if your baby is growing correctly. It also can help determine gestational age (term to describe how far along the pregnancy is) and your baby's position in your uterus. It's measured in centimeters with measuring tape. After about 20 weeks of pregnancy, your fundal height in centimeters should be close to your baby's gestational age. For example, if you are 24 weeks pregnant, your fundal height should be around 24 centimeters.

When do doctors measure fundal height?

Your healthcare provider measures fundal height at each prenatal appointment beginning at about 20 weeks in pregnancy. This is the approximate time when fundal height and gestational age begin matching each other.

Healthcare providers measure fundal height by locating your symphysis pubis and your fundus. Your symphysis pubis is a cartilage joint located between your pubic bones. The fundus is the top portion of your uterus. They may press down and feel around to find your fundus.

First, you will lay back on the exam table. Then, your healthcare provider will extend a paper or plastic tape measure from the top of your symphysis pubis (pubic bone) to your uterus (fundus). The distance between these two spots is your fundal height.

The location of your fundus moves as your pregnancy progresses. At about 12 weeks in pregnancy, your fundus is in almost the same spot as your pubic bone. By the time you reach 20 weeks, your fundus is at your belly button. This is about the time your fundal height and week of pregnancy begin to match one another.

At around 36 weeks, your fundus reaches your sternum or breastbone (the highest point it will reach). After 36 weeks, your fundal height can decrease. This can be because your baby has engaged into your pelvis to prepare for labor or for other reasons. Your provider may order additional tests to confirm there aren’t other causes for the decrease in fundal height.

How accurate is fundal height measurement?

Fundal height is one of the simplest and least invasive tools for tracking your baby's growth. It can be the first indication of growth problems or problems with your baby's position.

Your healthcare provider will order an ultrasound if your fundal height is concerning. Ultrasounds are more accurate at predicting your baby's size, but are only recommended two times during pregnancy (unless medically necessary).

Nothing is 100% accurate when it comes to estimating your baby's size in utero. It's common for your baby's size to be off by a centimeter or two. Your healthcare provider will do further testing if there is a reason to be concerned.

What does fundal height tell you about your baby?

Fundal height tells your healthcare provider important things about your baby's size, growth and position in your uterus. It helps confirm that your baby is growing as they should. It can also tell them how much amniotic fluid is in your uterus. Too little or too much amniotic fluid can indicate a problem.

Your fundal height in centimeters should be close to the number of weeks you are in pregnancy, plus or minus 2 centimeters. However, this is only the case from about weeks 20 to 36. Before 20 weeks of pregnancy, your fundus is not high enough. After 36 weeks of pregnancy, your fundus starts to go down. This is because your baby has dropped into your pelvis to prepare for labor. If this drop doesn't happen, this can indicate your baby is breech.

For example, if you are 32 weeks pregnant, a fundal height of 30 to 34 centimeters is an acceptable size.

Does fundal height indicate baby size?

Yes, fundal height can help indicate your baby's size. In addition to measuring fundal height, your healthcare practitioner will feel your abdomen to get an idea of your baby's size and position in the womb. It's important to remember that fundal height is_ _just an estimate. If your baby's size is a concern at any point in your pregnancy, your healthcare provider will recommend further testing.

When should I worry about my fundal height?

Your fundal height is usually not a reason for worry. It's OK for it to be off by at least two weeks or 2 centimeters. Your healthcare provider will review your medical history and decide if further tests are needed. It could simply be that your due date is wrong or that your baby is slightly smaller or larger than average.

Healthcare providers don't use fundal height to measure your due date. Fundal height is used to track how big or small your baby is compared to their gestational age. The best way to determine your baby's due date is to count 40 weeks (280 days) from the first day of your last menstrual period. Healthcare providers often use the first-trimester ultrasound to help determine gestational age and due date.

Some reasons why your baby could be measuring small or behind for gestational age are:

• You are petite or have strong abdominal muscles.
• You have oligohydramnios (not enough amniotic fluid).
• Your baby has already dropped into your pelvis.
• Your baby has fetal growth restriction (several conditions can cause this).

If your healthcare provider is concerned about your baby's size, they may order an ultrasound or additional tests to take a closer look.

Some reasons your baby is measuring ahead or large for gestational age are:

Sometimes there is no cause and your baby is just bigger than other babies the same age. Other times, your fundal height is large because your abdomen is overstretched from prior pregnancies or your bladder is full.

What is a normal fundal height after delivery?

Your uterus will go back to its pre-pregnancy size in about six weeks. At about an hour after childbirth, your fundus should be around your belly button (where it was at 20 weeks). After that, it should steadily decrease 1 centimeter every 24 hours. At about one week postpartum, your fundus should be at your pubic bone (where it was at 12 weeks). In most cases, by the time you return for your postnatal visit, your fundus has returned to its original location.

A note from Cleveland Clinic

Measuring your fundal height is one way your healthcare provider can make sure your baby's growth is on track. If you're told your baby measures ahead or behind schedule, try not to worry. It usually just means an ultrasound or further testing is needed. Your baby is more than likely developing perfectly. Talk to your healthcare provider if you have any concerns about your fundal height or the size of your baby.

Last reviewed by a Cleveland Clinic medical professional on 01/25/2022.

References

• ACOG. 2017. Method for estimating due date. (https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/05/methods-for-estimating-the-due-date) Committee opinion number 700. American College of Obstetricians and Gynecologists. Accessed 1/26/2022.
• ACOG. 2019. Practice bulletin 204: Fetal growth restriction. (https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2021/02/fetal-growth-restriction) American College of Obstetricians and Gynecologists. Accessed 1/26/2022.
• Haragan AF, Hulsey TC, Hawk AF, Newman RB, Chang EY. Diagnostic accuracy of fundal height and handheld ultrasound-measured abdominal circumference to screen for fetal growth abnormalities. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4465094/) Am J Obstet Gynecol. 2015;212(6):820.e1-820.e8208. Accessed 1/26/2022.
• Liu Q, Yang H, Sun X, Li G. Risk factors and complications of small for gestational age. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6717459/) Pak J Med Sci. 2019;35(5):1199-1203. Accessed 1/26/2022.
• Robert Peter J, Ho JJ, Valliapan J, Sivasangari S. Symphysial fundal height (SFH) measurement in pregnancy for detecting abnormal fetal growth. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6465049/) Cochrane Database Syst Rev. 2015;2015(9):CD008136. Published 2015 Sep 8. Accessed 1/26/2022.

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