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Delivery Write Up

A case study presented to

The faculty of School of Nursing

University of Baguio

In

Partial fulfillment of the

Requirements for the subject

Presented by:

Gatuslao, Mark Noriel

Garma, Princess Ashley

Oca, Geraldine

Pataueg, Krishna Jane

October 2019
Chapter I

Patient’s Profile

Name

Address

Age

Sex

Occupation

Religion

Nationality

Hospital
Name

Name of
Infant
Time of
Delivery

Date of
Delivery
Admitting
Diagnosis
Final
Diagnosis
Chapter II

Discussion of Conception

Conception is the time when sperm travels up through


the vagina, into the uterus, and fertilizes an egg
found in the fallopian tube.

Conception — and ultimately, pregnancy — can involve a


surprisingly complicated series of steps. Everything
must fall into place for a pregnancy to be carried to
term.
When does conception occur?

Conception occurs during the part of a woman’s


menstrual cycle called ovulation. Doctors consider day
1 of a menstrual cycle the first day of a woman’s
period.

Ovulation usually occurs around the midpoint of a


woman’s menstrual cycle. This would fall around day 14
in a 28-day cycle, but it’s important to remember that
even normal cycle lengths can vary.

During ovulation, one of the ovaries releases an egg,


which then travels down one of the fallopian tubes. If
there’s sperm present in a woman’s fallopian tube when
this happens, the sperm could fertilize the egg.

Usually, an egg has about 12 to 24 hours where it can


be fertilized by sperm. However, sperm can live for
several days in a woman’s body.

Therefore, when the ovary releases the egg, sperm that


are already present from intercourse a few days before
could fertilize it. Or, if a woman has sex during the
time the egg has been released, the sperm could
fertilize the just-released egg.
Conception comes down to timing, the health of a
woman’s reproductive tract, and the quality of a man’s
sperm.

Most doctors usually recommend having unprotected sex


starting about three to six days before you ovulate, as
well as the day you ovulate if you wish to become
pregnant. This increases the chances that sperm will be
present in the fallopian tube to fertilize the egg once
it’s released.
Conception-related concerns

Conception requires several steps to come together.


First, a woman must release a healthy egg. Some women
have medical conditions that prevent them from
ovulating altogether.

A woman must also release an egg healthy enough for


fertilization. A woman is born with the number of eggs
she will have throughout her lifetime. As she gets
older, the quality of her eggs diminishes.

This is most true after age 35, according to the Royal


College of Obstetricians and Gynaecologists trusted
Source.

High-quality sperm are also required to reach and


fertilize the egg. While only one sperm is needed, the
sperm must travel past the cervix and uterus into the
fallopian tubes to fertilize the egg.

If a man’s sperm aren’t motile enough and can’t travel


that far, conception can’t occur.

A woman’s cervix must also be receptive enough for the


sperm to survive there. Some conditions cause the sperm
to die before they can swim to the fallopian tubes.

Some women may benefit from assisted reproductive


technologies like intrauterine insemination or in vitro
fertilization if there are issues preventing healthy
sperm from meeting a healthy egg naturally.
Where does conception occur?

Sperm usually fertilizes the egg in the fallopian tube.


This is a pathway from the ovary to a woman’s uterus.
An egg takes about 30 hours to travel from the ovary
down the fallopian tube, according to the University of
California San Francisco.

As the egg travels down the fallopian tube, it lodges


in a specific portion called the ampullar-isthmic
junction. It’s here that sperm usually fertilize the
egg.

If the egg is fertilized, it will usually rapidly


travel into the uterus and implant. Doctors call the
fertilized egg an embryo.
Implantation-related concerns

Unfortunately, just because an egg is fertilized, it


doesn’t mean that a pregnancy will occur.

It’s possible to have damaged fallopian tubes due to a


history of pelvic infections or other disorders. As a
result, the embryo could implant in the fallopian tube
(improper location), which would cause a condition
called an ectopic pregnancy. This can be a medical
emergency because the pregnancy cannot continue and can
cause fallopian tube rupture.

For other women, the blastocyst of fertilized cells may


not implant at all, even if it reaches the uterus.

In some cases, a woman’s uterine lining isn’t thick


enough for implantation. In other cases, the egg,
sperm, or portion of the embryo may not be high quality
enough to successfully implant.
How does conception result in pregnancy?

After a sperm fertilizes an egg, cells in the embryo


start to rapidly divide. After about seven days, the
embryo is a mass of multiplied cells known as a
blastocyst. This blastocyst will then ideally implant
in the uterus.

As the egg travels through the fallopian tube before


implantation, though, the levels of the hormone
progesterone begin rising. The increased progesterone
causes the uterine lining to thicken.

Ideally, once the fertilized egg arrives in the uterus


as a blastocyst embryo, the lining will be thick enough
so it can implant.

Altogether, from the point of ovulation to


implantation, this process can take about one to two
weeks. If you have a 28-day cycle, this indeed takes
you to day 28 — usually the day when you would start
your period.
It’s at this point that most women can consider taking
an at-home pregnancy test to see if they’re pregnant.

At-home pregnancy tests (urine tests) work by reacting


with a hormone present in your urine known as human
chorionic gonadotropin (hCG). Also known as the
“pregnancy hormone,” hCG increases as your pregnancy
progresses.

Keep a few things in mind as you take an at-home


pregnancy test:

First, the tests vary in their sensitivity. Some may


require higher amounts of hCG to yield a positive.

Second, women produce hCG at varying rates when they


get pregnant. Sometimes a pregnancy test can yield a
positive one day after a missed period, while others
can take a week after a missed period to show a
positive.
Chapter III

Anatomy and Physiology

External Female Reproductive System

1. Mons Pubis is an area of fatty tissue that covers


the pubic bone in both males and females, though it
tends to be more prominent in females. It plays an
important role in secreting pheromones responsible
for sexual attraction.
2. Labia Majora are a pair of rounded folds of skin
and adipose that are part of the external female
genitalia. Their function is to cover and protect
the inner, more delicate and sensitive structures
of the vulva, such as the labia minora, clitoris,
urinary orifice, and vaginal orifice
3. Clitoris is a small projection of erectile tissue
in the vulva of the female reproductive system. It
contains thousands of nerve endings that make it an
extremely sensitive organ. Touch stimulation of the
nerve endings in the clitoris produces sensations
of sexual pleasure. The clitoris is structurally
and functionally homologous to the penis of the
male reproductive system, except that the clitoris
does not contain the urethra and plays no role in
urination.
4. Labia Minora are a pair of thin cutaneous folds
that form part of the vulva, or external female
genitalia. They function as protective structures
that surround the clitoris, urinary orifice, and
vaginal orifice.
5. Vaginal opening it is located between the urethra
and the anus. The opening is where menstrual blood
leaves the body. It is also used to birth a baby
and for sexual intercourse. The exterior opening to
the vagina, the muscular canal that extends from
the cervix to the outside of the female body. Also
called vaginal introitus and vaginal vestibule.
6. Hymen is a thin membrane that surrounds the opening
of the vagina. Hymens can come in different shapes.
The most common hymen is shaped like a half moon).
This shape allows menstrual blood to flow out of
the vagina. It can serve a protective purpose by
helping to prevent things from being pushed into
the vagina; sometimes, a damaged hymen is looked at
as an indicator of abuse and incest.
7. Perineum is separated from the pelvic cavity
superiorly by the pelvic floor. This region
contains structures that support the urogenital and
gastrointestinal systems – and it therefore plays
an important role in functions as such micturition,
defecation, sexual intercourse and childbirth.
8. Urethral opening is the external opening of the
transport tube that leads from the bladder to
discharge urine outside the body in a female. The
urethra in a female is shorter than the urethra in
the male. The meatus (opening) of the female
urethra is below the clitoris and just above the
opening of the vagina.
Internal Female Reproductive System

1. Fundus is a part of the uterus . It is found at the


top portion, opposite from the
cervix. Fundal height, measured from the top of the
pubic bone, is routinely measured in pregnancy to
determine growth rates.
2. Fallopian tube is also called oviduct or uterine
tube, either of a pair of long, narrow ducts
located in the human female abdominal cavity that
transport male sperm cells to the egg, provide a
suitable environment for fertilization, and
transport the egg from the ovary, where it is
produced, to the central channel (lumen) of
the uterus.
3. Ovary is a ductless reproductive gland in which
the female reproductive cells are
produced. Females have a pair of ovaries, held by a
membrane beside the uterus on each side of the
lower abdomen. The ovary is needed in reproduction
since it is responsible for producing
the female reproductive cells, or ova.
4. Uterus also known as the womb, is the hollow organ
in the female reproductive system that holds a
fetus during pregnancy. The uterus performs
multiple functions and plays a major role in
fertility and childbearing. This organ is able to
change in shape as muscles tighten and relax to
make it possible to carry a fetus.During pregnancy,
the uterus grows and the muscles become stretched
and thinner, like a balloon. Without this ability
to expand, the human body would be unable to
tolerate the rapid growth of a fetus
5. Endometrium is the innermost lining layer of the
uterus, and functions to prevent adhesions between
the opposed walls of the myometrium, thereby
maintaining the patency of the uterine cavity.
During the menstrual cycle or estrous cycle,
the endometrium grows to a thick, blood vessel-
rich, glandular tissue layer.
6. Cervix is the lower most part of the uterus and is
made up of strong muscles. The function of
the cervix is to allow flow of menstrual blood from
the uterus into the vagina, and direct the sperms
into the uterus during intercourse. The opening of
the cervical canal is normally very narrow.
7. Vagina is an elastic, muscular canal with a soft,
flexible lining that provides lubrication and
sensation. The vagina connects the uterus to the
outside world. The vagina receives the penis during
sexual intercourse and also serves as a conduit for
menstrual flow from the uterus.
Anomalies of the female genital tract

Structural anomalies of the female genital tract may be


present at birth or may be acquired later in life.
Anomalies of the uterus

Anomalies of Müllerian duct fusion

 Pathophysiology

 Defective fusion of the Müllerian ducts during


embryonal development

 Normally
functioning gonads and female karyotype →
normal development of secondary sexual
characteristics (e.g., breast,
pubic hair development)

Anomalies of Müllerian duct fusion


Types of fusion Relativ Pathophysiology
anomalies e
frequen
cy

Müllerian Rare Both the Müllerian ducts fail


agenesis to develop → absent
or hypoplastic uterus,
absent cervix, and vaginal
atresia

Unicornuate 10% One of the Müllerian ducts


uterus fails to develop

Didelphic 8% Complete lack of Müllerian


uterus (Class duct fusion → double uterus,
III) double cervix, double vagina

Bicornuate 26% Incomplete fusion of the


uterus Müllerian ducts to various
degrees

 Uterus bicornis unicollis:


double uterus,
single cervix, and
single vagina

 Uterus bicornis bicollis:


double uterus and
double cervix with/without
a vaginal septum

Septate uterus 35% The Müllerian ducts fuse, but


the septa between the two
ducts persists either partially
(subseptate uterus) or
Anomalies of Müllerian duct fusion

Types of fusion Relativ Pathophysiology


anomalies e
frequen
cy

completely (septate uterus).

DES- Rare In-utero exposure


related abnorma to diethylstilbestrol
lity
 Vagina: adenosis, adenocar
cinoma

 Cervix: cockscomb cervix,


cervical collar

 Uterus: hypoplasia, uterin


e synechiae, T-
shaped uterine cavity

 Fallopian tube:
abnormal fimbriae, cornual
budding
Intrauterine adhesions (Asherman syndrome)

Etiology

Following uterine curettage (most common cause)

Postinflammatory (e.g., chlamydia)


Anomalies of the vulva and vagina

Imperforate hymen

Definition: a hymen without an opening

Etiology: congenital defect

Pathophysiology: central cells of the Müllerian


eminence in the urogenital sinus do not disintegrate →
imperforate hymen → cryptomenorrhea at puberty (outflow
tract obstruction leads to backup of menstrual blood) →
hematocolpos

Vaginal atresia

Etiology: Müllerian agenesis


Pathophysiology

Agenesis or hypoplasia of the Müllerian duct → atresia


of the upper ⅓ of the vagina

Normally functioning gonads and female karyotype →


normal development of secondary sexual characteristics
(e.g., breast, pubic hair development)

Associated anomalies

Absent or malformed uterus and cervix (in almost all


cases)

Urological malformations (25–50% of cases): single


kidney, pelvic kidney, horseshoe kidney

Skeletal malformations (10–15% of cases)

Transverse vaginal septum

Pathophysiology: Failure of recanalization of the


Müllerian duct → transverse septum in the upper-third
(45%), lower third (15–20%), and/or middle third (35–
40%) of the vagina

Associated with cervical hypoplasia or absence

Cryptomenorrhea → hematocolpos
Labial fusion

Definition: partial or complete adhesion of the labia


minora

Etiology:

Absence of estrogen → predisposition to mild infection


→ local inflammation → raw surface epithelium of the
labia minora → adhesions

In rare cases: trauma (sexual abuse), congenital defect


Chapter IV

Stages of Labor

Early Labor Phase

The time of the onset of labor until the cervix is


dilated to 3 cm.
What to do:

During this phase, you should just try to relax. It is


not necessary to rush to the hospital or birth center.
Try to enjoy the comfort of the familiar surroundings
at home. If early labor occurs during the day, do some
simple routines around the house.

Keep yourself occupied while conserving your energy.


Drink plenty of water and eat small snacks. Keep track
of the time of your contractions. If early labor begins
during the night, it is a good idea to try to get some
sleep. If you are unable to fall asleep, focus on doing
some light activities like cleaning out your closet,
packing your bag, or making sack lunches for the next
day.
What to expect:

 Early labor will last approximately 8-12 hours


 Your cervix will efface and dilate to 3 cm
 Contractions will last about 30-45 seconds,
giving you 5-30 minutes of rest between
contractions

 Contractions are typically mild and somewhat


irregular but become progressively stronger and
more frequent

 Contractions can feel like aching in


your lower back, menstrual cramps, and
pressure/tightening in the pelvic area

 Your water might break – this is known as


amniotic sac rupture and can happen anytime within
the first stage of labor.
Active Labor Phase

Continues from 3 cm. until the cervix is dilated to 7


cm.

What to do:

Now is time for you to head to the hospital or birth


center. Your contractions will be stronger, longer
and closer together. It is very important that you
have plenty of support. It is also a good time
to start your breathing techniques and try a
few relaxation exercises between contractions.

You should switch positions often during this time.


You might want to try walking or taking a warm bath.
Continue to drink plenty of water and urinate
periodically.
What to expect:

 Active labor will last about 3-5 hours

 Your cervix will dilate from 4cm to 7cm

 Contractions during this phase will last about 45-


60 seconds with 3-5 minutes rest in between

 Contractions will feel stronger and longer

 This is usually the time to head to the hospital or


birth center
Transition Phase

Continues from 7 cm. until the cervix is fully dilated


to 10 cm.
What to do:
During this phase, the mother will rely heavily on her
support person. This is the most challenging phase, but
it is also the shortest. Try to think “one contraction
at a time” (this may be hard to do if the contractions
are very close together). Remember how far you have
already come, and when you feel an urge to push, tell
your health care provider.
What to expect:

 The transition will last about 30 min-2 hrs

 Your cervix will dilate from 8cm to 10cm

 Contractions during this phase will last about 60-


90 seconds with a 30 second-2 minute rest in
between

 Contractions are long, strong, intense, and can


overlap

 This is the hardest phase but also the shortest


 You might experience hot flashes,
chills, nausea, vomiting, or gas