Fundal massage

Fundal massage is a manual technique used primarily in the postpartum period to encourage the uterus to contract and prevent postpartum hemorrhage, a leading cause of maternal mortality worldwide. This procedure is a critical component of the active management of the third stage of labor, which also includes the administration of uterotonic drugs and controlled cord traction.

Procedure

Fundal massage involves the external manipulation of the abdominal area where the uterus is located, immediately after the delivery of the placenta. The healthcare provider places one hand just above the woman's pubic bone to support the lower uterus and uses the other hand to gently but firmly massage the fundus (the top portion of the uterus) in a circular motion. This action stimulates the uterus to contract, helping it to shrink back to its pre-pregnancy size and reducing the risk of postpartum hemorrhage by compressing the blood vessels in the uterine wall.

Indications

The primary indication for fundal massage is to prevent or control postpartum hemorrhage immediately after childbirth. It is also performed periodically in the immediate postpartum period as part of routine postnatal care, especially in women with a history of postpartum hemorrhage or other risk factors for excessive bleeding.

Contraindications

There are few absolute contraindications to fundal massage, but it should be performed with caution in women with certain conditions such as:

• Uterine inversion
• Uterine rupture
• Placenta accreta, increta, or percreta (until confirmed that the placenta has been completely delivered)

Risks and Complications

While fundal massage is generally safe, it can be uncomfortable or painful for the postpartum woman. Excessive force during massage can also lead to uterine inversion or rupture in very rare cases. Proper technique and gentle handling are essential to minimize discomfort and prevent complications.

Effectiveness

Fundal massage, when combined with the administration of uterotonic drugs, is effective in reducing the incidence of postpartum hemorrhage. It is a simple, cost-effective intervention that can be performed in any setting, making it particularly valuable in low-resource environments.

Training and Implementation

Healthcare providers, including midwives, nurses, and physicians, should receive training in the proper technique for fundal massage. Standardized protocols can help ensure that fundal massage is performed consistently and effectively as part of postpartum care.

Cultural Considerations

Cultural sensitivity is important in the implementation of fundal massage, as postpartum practices vary widely across different cultures. Healthcare providers should be aware of and respect cultural practices and preferences related to postpartum care.

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