At 72 hours postpartum, which fundal finding should prompt reporting to the provider?

• A. Fundus above the umbilicus
• B. Fundus soft and below the umbilicus
• C. Fundus firm at the level of the umbilicus
• D. Fundus cannot be palpated

Answer: (B)

Postpartum uterine involution and tone determine the risk of hemorrhage. By 72 hours after birth, the uterus should be firm and located in the pelvis, typically at or just below the level of the pubic symphysis. A fundus that is soft (boggy) and located below the umbilicus indicates the uterus is not contracting effectively, which raises the risk for postpartum hemorrhage and requires prompt evaluation and intervention (fundal massage, ensuring the bladder is empty, and any ordered uterotonic medications). This finding is the most concerning at this stage because tone is crucial for contraction and hemostasis.

A fundus above the umbilicus would also be abnormal and warrant assessment, but the key urgent signal among these options is a soft, boggy fundus below the umbilicus. A firm fundus at the umbilicus or higher might suggest incomplete involution but is less immediately alarming than a boggy uterus. Not being palpable can occur as the uterus descends into the pelvis and is not necessarily an acute problem at this time.