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The fundus may be monitored because a rising fundus can indicate bleeding. An ultrasound may be used to rule out placenta praevia but is not diagnostic for abruption. [ 8 ] The diagnosis is one of exclusion, meaning other possible sources of vaginal bleeding or abdominal pain have to be ruled out in order to diagnose placental abruption. [ 5 ]
As the fetal hypothalamus matures, the activation of the hypothalamic–pituitary–adrenal (HPA) axis initiates labor through two hormonal mechanisms. The end pathway of both mechanisms lead to contractions in the myometrium, a mechanical cause of placental separation, which is due to the sheer force and contractile and involutive changes that occur within the uterus, distorting the placentome.
Normal puerperal uterus may be displaced by a full bladder or a loaded rectum. It feels boggy and softer upon palpation. The presence of features responsible for subinvolution may be evident.
Illustration of fundal height at various points during pregnancy Some degree of weight gain is expected during pregnancy. The enlarging uterus, growing fetus, placenta , amniotic fluid , normal increase in body fat, and increase in water retention all contribute weight gain during pregnancy.
After birth, the fundus contracts downward into the pelvis one centimeter each day. After two weeks the uterus will have contracted and return into the pelvis. [9] The sensation and strength of postpartum uterine contractions can be stronger in women who have previously delivered a child or children. [10]
The postpartum period can be divided into three distinct stages; the initial or acute phase, 8–19 hours after childbirth; subacute postpartum period, which lasts two to six weeks, and the delayed postpartum period, which can last up to six months. [5] In the subacute postpartum period, 87% to 94% of women report at least one health problem.
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Routine use of fundal massage can prevent postpartum or post-abortion hemorrhage and can reduce pain; it may also reduce the need for uterotonics, medications that cause the uterus to contract. It is used to treat uterine atony , a condition where the uterus lacks muscle tone and is soft to the touch instead of firm.