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NORMAL
LABOR
Presentor:
Clerk SEMJON TSYRLIN
Objectives
To present a case of a normal
conduct of labor
To discuss the normal conduct of
labor
To discuss the management of
normal conduct of labor
General Data
Chief Complaint
Bloody Mucoid Discharge
(-)
(-)
(-)
(-)
(-)
DM
HPN
Asthma
Thyroid Disease
Hospitalization
(-) HPN
(-) Diabetes Mellitus
(-)CA
(-) Thyroid disease
Menstrual History
Menarche at 11 years old lasted for
3-5 days
Interval: 28-30 days
3-5 days duration
1-2 moderately soaked regular
pads/day
Denies dysmenorrhea.
Sexual History
Contraceptive History
No history of contraceptive use
Gynecological History
(-) Leucorrhea
(-) Vaginal pruritus
(-) Pap smear done
Obstetrical History
G2P1 (1001)
YEAR
G
1
G
2
SEX
COMPLICATIO
NS
none
Prenatal History
At 8 weeks amenorrhea
Suspected pregnancy
No consult done
No medications taken
At 16 weeks AOG
Quickening was noted
No consult done
At 20 weeks AOG
Consult at Private OB
Ultrasound confirmed pregnancy
Prenatal History
At 21-27 wks AOG- irregular PNCU at
Health center
At 28 weeks AOG
First prenatal check-up at Jonelta OPD
Laboratories ordered:
Prescriptions:
Multivitamins
Folic acid
Prenatal History
At 30 weeks AOG
Laboratory results from 2 weeks prior:
Prescriptions:
Cefalexin 500mg, QID, for 7 days
At 32 weeks AOG
Repeat U/A was normal- UTI resolved
Repeat CBC showed anemia
Patient was again prescribed MVTs OD, FeSO4
BID and Ascorbic acid OD.
Prenatal History
At 33-35 weeks AOG- regular PNCU and
regular intake of Multivitamins and
supplements
At 36 weeks AOG
Patients anemia resolved
Advised weekly prenatal checkups and fetal
health monitoring
At 37 weeks AOG
Unremarkable findings
Good fetal movement, FHT 140s, FH 32cm.
History
of
Pregnancy/Illness:
3 hours PTA
(+) labor pains
(-) watery vaginal discharge
(-) bloody show
no consult done
1 hour PTA
(+) labor pains
(+) bloody show
Present
Review of Systems
CNS: (-) Loss of consciousness (-)
Dizziness (-) Headache
CVS: (-) Chest pain (-) easy
fatigability
Respiratory: (-) DOB (-) cough (-)
colds
GIT: (-) Vomiting (-) Nausea (-)
Constipation
GUT: (-)Dysuria (-) Polyuria (-)
Hematuria
PHYSICAL
EXAMINATION
General Survey:
Ambulatory, conscious, coherent, afebrile, not in
cardiorespiratory distress
Vital Signs:
Skin:
Warm to touch, good skin turgor
HEENT:
Pink palpebral conjunctiva, anicteric sclerae, no
nasoaural discharge, moist lips and oral mucosa
Chest/Lungs:
Symmetric chest expansion, no retraction, clear breath
sounds
Heart:
Adynamic precordium, normal rate, regular rhythm, no
murmur
Abdomen
&
Examination
Abdomen:
Pelvic
Globular
FH: 28cm
FHT: 140s LLQ EFW: 2.48kgs
2-3 mild to moderate contractions in 15 mins
LEOPOLDS MANEUVER:
L1: breech
L2: Fetal small parts Right; Fetal back - Left
L3: cephalic
L4: Not engaged
Pelvic Exam
I: Parous introitus
SE: Cervix violaceous, (+) bloody mucoid discharge
IE: 5cm, 70% effaced, cephalic, (+) BOW, st-2
Initial Assessment
UPON ADMISSION
Plan:
Stable vital signs
Good fetal movement
FHT 140s
NPO
IVF: D5LR 1L x 8hours
Medications:
Ampicillin 1g TIV
10 units of Oxytocin
incorporated to present IVF
For NSD barring complications
regulated at 8-10 gtts/min
Nalbuphine 10mg IM
Diagnostics:
Methylergometrine
CBC with platelet count
1 amp IM/IV Medications:
(Leukocytosis)
Ampicillin 1g TIV
Urinalysis (Normal)
Monitor progress of labor, vital
signs, FHT and contractions
BASELINE
CARDIOTOCOGRA
M:
Shows reassuring
fetal heart rate
pattern
Postpartum orders:
DAT
IVF with oxytocin incorporation
was continued
Medications were:
- Cefuroxime 500 mg/cap BID
- Mefenamic acid 500 mg/cap TID
PRN
- Methylergometrine 1 tablet TID for
Home Rx
Final Assessment
G2P2 (2002) PREGNANCY
UTERINE, DELIVERED FULL
TERM, CEPHALIC, LIVE BABY
GIRL, BIRTHWEIGHT 3.0KG,
APPROPRIATE FOR GESTATIONAL
AGE, NORMAL SPONTANEOUS
DELIVERY, RIGHT MEDIOLATERAL
EPISIOTOMY & REPAIR, 2ND
DEGREE, UNDER IV SEDATION.
Normal
Conducti
on of
Labor
LABOR
Period from the onset of regular
uterine contractions until expulsion
of the placenta
False Labor
Contractions
Regular
Irregular
Interval
Regular
Irregular
Intensity
Shorter
Long
Discomfort
Chiefly lower
abdomen
Cervical
Dilatation
Increases
Unchanged
Sedation
No relief*
With relief
Mechanism of Labor
Fetal position within the uterine
cavity at the onset of labor with
respect to the birth canal
critical to the route of delivery
Fetal Orientations:
Lie
Presentation
Attitude
Position
Fetal Lie
The relation of the long axis of the
fetus to that of the mother
Longitudinal (99%)
Transverse
Predisposing factors:
Multiparity
Placenta Previa
Hydramnios
Uterine Anomalies
Oblique
Fetal Presentation
Portion of the fetal body that is either
foremost within the birth canal or in
closest proximity to it
Longitudinal lies
Fetal head : Cephalic presentation
Breech : Breech presentation
Transverse lies
Shoulder presentation
Cephalic Presentation
BREECH PRESENTATION
Breech presentation
Frank breech- thighs are flexed with legs
extended
Complete breech- thighs flexed, legs flexed
Footling one or both thighs are extended
Fetal Position
Position refers to the relationship of
an arbitrarily chosen portion of the
fetal presenting part to the right or
left side of the maternal birth canal
Abdominal Palpation
Leopold Maneuvers
First Maneuver
This maneuver permits identification
of which fetal polethat is, breech or
headoccupies the uterine fundus.
The breech gives the sensation of a
large, nodular mass, whereas the
head feels hard and round and is
more mobile and ballottable.
Second Maneuver
Palms are placed on either side of the
maternal abdomen, and gentle but deep
pressure is exerted. On one side, a hard,
resistant structure is feltthe backand
on the other, numerous small, irregular,
mobile parts are feltthe fetal extremities
Third Maneuver
Using the thumb and fingers of one
hand, the lower portion of the
maternal abdomen is grasped just
above the symphysis pubis. If the
presenting part is not engaged, a
movable mass will be felt, usually the
head. The differentiation between
head and breech is made as in the
first maneuver
Fourth Maneuver
The examiner faces the mother's feet
and, with the tips of the first three
fingers of each hand, exerts deep
pressure in the direction of the axis
of the pelvic inlet.
Methylergometrine
Promotes uterine
contractions
Prevents uterine atony
Characteristic
Midline
Mediolateral
Surgical repair
Easy
More difficult
Faulty healing
Rare
More common
Postoperative pain
Minimal
Common
Anatomical results
Excellent
Occasionally faulty
Blood loss
Less
More
Dyspareunia
Rare
Occasional
Extensions
Common
Uncommon
Decelerations
Early: physiologic
Variable: usually due to cord head
compression
May be physiologic or pathologic