In the postpartum assessment, the lochia is moderate and rubra, the uterus is firm, and palpable 2 cm above the umbilicus near the left side. What is the most likely cause for this finding?

In the postpartum assessment, the lochia is moderate and rubra, the uterus is firm, and palpable 2 cm above the umbilicus near the left side. What is the most likely cause for this finding?

• A. Postpartum hemorrhage
• B. A uterine infection
• C. A full bladder
• D. Normal uterine involution

Answer: (C)

A full bladder commonly causes the uterus to be displaced upward and to one side in the immediate postpartum period. Even when the uterus is firm and lochia is moderate and rubra (which are reassuring signs and not indicative of hemorrhage or infection), a distended bladder can push the uterus 2 cm above the umbilicus and off-center, typically to the left due to bladder position. This displacement resolves when the bladder is emptied, whereas true postpartum hemorrhage would present with a boggy uterus and heavy bleeding, infection would show foul lochia and possibly fever, and normal involution would have the uterus descending toward the pelvis and becoming closer to midline over time. So the most likely cause for this finding is a full bladder.

A full bladder commonly causes the uterus to be displaced upward and to one side in the immediate postpartum period. Even when the uterus is firm and lochia is moderate and rubra (which are reassuring signs and not indicative of hemorrhage or infection), a distended bladder can push the uterus 2 cm above the umbilicus and off-center, typically to the left due to bladder position. This displacement resolves when the bladder is emptied, whereas true postpartum hemorrhage would present with a boggy uterus and heavy bleeding, infection would show foul lochia and possibly fever, and normal involution would have the uterus descending toward the pelvis and becoming closer to midline over time. So the most likely cause for this finding is a full bladder.