Maybe you’ve already come across it in your maternity record or heard the term in childbirth preparation classes: fundal height. In this article, we’ll explain what fundal height actually is, how it’s measured, and what the different values and abbreviations mean.

What is the fundus position?

As the fundus, midwives and medical professionals refer to the upper edge of the uterus. Fundal height indicates the distance between the fundus and various fixed points : At the beginning of pregnancy, this is the distance between the fundus and the pubic bone , and later between the fundus and the navel or rib arch . This makes it possible to measure how far the uterus extends upward during pregnancy. The value can then provide insights into your pregnancy week as well as your baby’s growth.

In the past, fundal height was considered the standard for measuring the uterus and tracking the progress of pregnancy, but today your baby’s development and the pregnancy week can be checked more accurately by ultrasound. It may also be that fundal height is difficult to palpate, for example if you have excess amniotic fluid or are overweight—in these cases, the check is often done exclusively by ultrasound.

How is the fundus position measured?

During your preventive examinations , your midwife or gynecologist/doctor will measure your fundal height by palpation using the so-called Leopold maneuvers . To do this, they place their hands flat on your abdomen and gently press to locate the measurement points. This is possible from the end of the third month, as before that the uterus is still in the small pelvis and cannot be felt from the outside. The measured value is then recorded after each examination on page 7 of your Mother’s Pass . It’s important that your bladder is empty during the examination to avoid distorting the results.

Feel the fundus position yourself

With a little practice, you can also feel your fundal height yourself at home—ideally, have your midwife or gynecologist show you how once. Lie down comfortably on your back and first locate your pubic symphysis. It feels bumpy and is located in the middle of your lower pelvis, above your pubic bone. Next, find your fundus, which should feel like a slight bump. Before the middle of pregnancy, you will usually find the fundus below your navel, and later above it. Now you only need a measuring tape, or you can measure with your fingers held horizontally to determine your fundal height.

Because your own measurements are often a bit less accurate, you don’t need to worry right away if your values differ from the standard values. It’s best to have your midwife or gynecologist check your values again.

Fundus Position Table

Here is an overview of which fundal height values are within the normal range and which abbreviation is entered in the maternal pass.

Causes of a deviating fundus position

Sometimes, a value higher or lower than the normal range may be measured. Often, harmless reasons—or simply a measurement error—are behind it, but more serious complications can also cause deviations. That’s why your fundal height and your baby’s development should be checked regularly.

Too high fundus level

• Multiple pregnancies : Whether twins , triplets, or even quadruplets—more babies need more space, so fundal height is often higher earlier on.

• Uterine fibroids: These are benign tumors that cause no symptoms in about half of women. However, pregnancy can stimulate growth due to increased hormone production and may enlarge the uterus, which can explain an elevated fundal height. In most cases, fibroids do not cause serious problems during pregnancy. However, you should discuss treatment with your gynecologist.

• Your child is growing excessively large (macrosomia): Some babies grow faster, others slower. However, if your baby weighs more than 95 percent of babies at this age during the examination, it is called macrosomia. Risk factors for this excessive growth include diabetes or pregnancy diabetes . If an estimated birth weight of 4,500 grams or more is calculated, then typically a cesarean section is advised.

• Too much amniotic fluid (polyhydramnios): An excessive amount of amniotic fluid can lead to an increase in abdominal circumference and, therefore, a higher fundal height. To avoid complications such as premature rupture of membranes or an abnormal fetal position, your doctor may perform an amniocentesis to remove some amniotic fluid for relief.

Too low fundus level

• Your baby is lying across : Your baby’s position in the womb can influence the value. Often, this is no reason to worry, and many babies move into the correct position during pregnancy for birth .

• Your baby is small: Many different causes can be responsible for this. Every child is individual and has their own pace of growth, and your body stature also influences your baby’s size, so minor fluctuations are normal. However, developmental disorders or malformations can also be responsible for a low fundal height. Your doctor should monitor growth and clarify it with further examinations.

• Too little amniotic fluid (oligohydramnios): The suspicion that you have too little amniotic fluid can arise if your uterine size is smaller than expected. Often, close monitoring of your baby’s development follows, as oligohydramnios can, among other things, lead to delayed or incomplete growth.

• Miscarriage: There are many possible causes for a miscarriage . One sign can be, among other things, a fundal height that is too low, indicating that the fetus is no longer developing. To rule out a miscarriage, various examinations are then carried out. The further along you are in pregnancy, the less likely a miscarriage is—according to the 16th week of pregnancy , the risk is less than 5 percent.

Fundal position after childbirth

Many women are surprised that they still look pregnant after childbirth—but this is more the rule than the exception. The reason is relaxed abdominal muscles and a uterus that is still enlarged. In the postpartum period , your body has time to regenerate and recover, and the uterus begins to shrink. The so-called false or Braxton Hicks contractions support this process. The postnatal healing process of your uterus can take between 4 and 6 weeks , but this varies greatly from woman to woman. You can tell how far healing has progressed by your lochia —its composition changes over time and turns from bloody red to yellowish-white. Your midwife can check how far the uterus has regressed by measuring fundal height:

• Immediately after birth Fundus 1 to 3 fingerbreadths below the navel

• 1. Tag nach der Geburt Fundus 1 transverse finger above the navel

• 5. Day after the birth : Fundus between the navel and pubic bone

• 10. Day after birth : Fundus just above the pubic bone

• After about 14 days, the fundal height should no longer be palpable.

Even here, minor deviations are often harmless. The reference values are only meant as a guide and shouldn’t cause you concern, as each uterus recovers at a different rate. The value is influenced, for example, by your baby’s size at birth, your body, as well as the course and type of delivery. For example, after a cesarean section, the uterus usually takes longer to return to its normal size than after a natural birth. Even if you have already had several children, recovery may take longer, as it takes more effort for your uterus to get back into shape.

If you’re unsure about your fundal height—whether during pregnancy or after birth—discuss your concerns with your midwife or gynecologist. We wish you a wonderful pregnancy!