Uterine palpation is a manual technique used to examine the size, position, and consistency of the uterus by feeling the abdomen with the hands. The primary purpose of this examination is to monitor uterine growth during pregnancy or track its return to a non-pregnant size, a process called involution, after childbirth. While this article details the technique for self-palpation, this information should never replace routine professional medical care or advice from a healthcare provider.
Locating the Uterus in Pregnancy
The fundus, the uppermost part of the uterus, changes position predictably as pregnancy progresses. Before approximately 12 weeks of gestation, the uterus remains within the pelvic cavity and is generally not palpable through the abdominal wall. By the 12th week, the fundus usually rises and becomes palpable just above the symphysis pubis.
The uterus continues its upward growth, reaching the level of the umbilicus at around 20 weeks of pregnancy. After this point, the distance from the pubic bone to the fundus, known as the fundal height, often correlates closely with the number of weeks of gestation, plus or minus two centimeters. The uterus typically reaches its highest point near the xiphoid process by 36 weeks.
After delivery, the uterus begins the process of involution. Immediately after childbirth, the fundus should be firm and located near the level of the umbilicus. It is expected to descend approximately one centimeter each day thereafter. By about 10 to 14 days postpartum, the uterus has descended back into the pelvic cavity, making it no longer palpable abdominally.
The Technique of Self-Palpation
Effective palpation requires proper positioning to ensure the abdominal muscles are relaxed and the uterus is accessible. Begin by emptying your bladder completely, as a full bladder can displace the uterus and alter the findings. Lie flat on your back with your knees bent slightly to ease tension in the abdominal wall.
Place the edge of one hand gently on your lower abdomen, just above the pubic bone. Apply light but steady pressure, using the pads of your fingers or the ulnar edge of your hand. You are searching for a firm, rounded, smooth structure beneath the skin, which is the uterine fundus.
If pregnant, start low near the pubic bone and slowly sweep your hand upward toward your belly button. Once you feel the fundus, measure its distance from the pubic bone or compare its location to the umbilicus. If postpartum, start near the umbilicus and sweep downward. Repeat the process with medium and then firmer pressure to assess the structure’s depth and consistency.
What Uterine Palpation Reveals
The act of palpation provides two main pieces of information: fundal height and uterine tone. Fundal height is the measurement from the pubic bone to the top of the uterus and is a primary indicator of growth during pregnancy. From 20 to 36 weeks, the number of centimeters generally approximates the gestational age in weeks, allowing for variation.
A fundal height that consistently measures smaller or larger than expected may suggest issues such as restricted fetal growth, multiple gestation, or an excess of amniotic fluid. After 36 weeks, the height may decrease as the fetus descends into the pelvis in preparation for labor. Tracking this height over time is more informative than a single measurement.
Uterine tone, or consistency, is particularly informative in the immediate postpartum period. A uterus that is contracting effectively should feel firm and hard. This firmness is a sign that the myometrium is clamping down on the blood vessels that supplied the placenta, which helps prevent excessive bleeding.
A uterus that feels soft, spongy, or mushy is described as “boggy,” indicating a lack of muscle tone, or uterine atony. Uterine atony is the most common cause of postpartum hemorrhage because the open blood vessels continue to bleed unchecked. If the fundus feels boggy, gentle massage is often the immediate action to encourage the muscle to contract and become firm.
Safety Guidelines and Medical Consultation
Always use gentle pressure when performing uterine palpation to avoid causing discomfort or injury. Never apply excessive force, particularly in the later stages of pregnancy or immediately following delivery. If any palpation causes pain, the examination should be immediately stopped.
Self-palpation should be avoided in certain high-risk situations. These include cases of known placenta previa, unexplained vaginal bleeding, or following any recent abdominal trauma. If a person has a history of uterine rupture or has recently had a Cesarean delivery, they should not perform self-palpation without consulting a medical professional.
Contact a healthcare provider immediately if you notice any concerning signs during or after palpation. These warning signs include a sudden drop in fundal height, which could indicate a complication. Excessive or persistent vaginal bleeding, or a fundus that remains persistently boggy despite gentle massage, requires medical evaluation, as these may signal a postpartum hemorrhage.