INTRODUCTION

The pregnancy poses a risk to the life of

every woman. Pregnant women may
suffer complications and die. The
detection and management of pregnancy
–related problems is directly related to
reducing causes and maternal morbidity.
 The prolonged pregnancy, also commonly
called post-term pregnancy, is one that has
lasted longer than 42 weeks or 294 days.
Beyond on the first day of last menstrual
period. Postadism implies pregnancy lasting
beyond the estimated due date at 40 weeks.
 Prolonged pregnancies are at risk for
macrosomia resulting in shoulder dystocia
and fetal injury, oligohydramnios, meconium
aspiration, entrapartum fetal distress, and
still birth. Maternal risk includes trauma,
hemorrhage, and labor abnormalities.
Interventions for preventing or improving
outcomes in low- risk, prolonged pregnancies
have proven to be of minimal benefit.
 The management of uncomplicated
prolonged pregnancies is controversial. An
adverse event in a pregnancy that has carried
beyond 40 weeks seems especially difficult
because it might have been avoided by
simply delivering the patient. Although rare,
the risk of still birth increases as gestational
age increase.
 INITIAL DATA BASE

NAME OF PATIENT: Ms. Hinata

SEX: female
EDUCATIONAL ATTAINMENT: High school
level
AGE: 21 years old
 CIVIL STATUS: single
NATIONALITY: Filipino
RELIGION: Roman Catholic
ADDRESS: Pajara, barangay Santa
Monica
BIRTHDATE: July 16, 1989
DATE AND TIME OF ADMISSION: August 2, 2010
/ 6:20 AM
 OCCUPATION: None
CHIEF COMPLAINT: Labor pains
DIAGNOSIS: G1P1 40 weeks of gestation
SOURCE OF INFORMATION: Patient and
Chart
 Obstetrical Data

• LMP: Oct. 27, 2010

• AOG: 40 weeks of gestation
• EDC: August 3, 2010
 FAMILY HISTORY

NAME OF FATHER: Mr. Gaara 

NAME OF MOTHER: Mrs. Sakura 
NO. OF CHILDREN IN THE FAMILY: 5 siblings 
PRESENCE OF HEREDITARY DISEASES:
 
Diabetes (-)
Cardiovascular diseases (-)
Bronchial asthma (-)
Other hereditary diseases (-)
 
 
 PHYSICAL ASSESSMENT
A. HEAD
Normocephalic; scalp is soft and non-
tender; no notable masses, scars and lesions;
hair is black, evenly distributed with dandruff
noted upon inspection; capable of neck flexion
and extension.
 B. EYES
  Eyebrows and eyelids are intact, lashes are present
on upper and lower lids and evenly distributed and it
turned outward; white sclera and iris is black; pupil
equally round and reactive to light accommodation;
with pupilary size of 2-3 mm on both eyes when
reacting to light; able to distinguished things around
(CN-II: optic intact); with good blinking and corneal
reflex; both eyes are coordinated in movement;
reported no blurring of vision.
 
 C. FACE
Symmetric; able to purposely and
symmetrically use facial muscles (CN-7: facial
intact); able to distinguished touch on both
sides of the face (CN V: Sensory Intact).
 
D. EARS
Same color with the facial skin; top of pinna
in line with outer canthus of the eye, bean
shaped; texture of the ear is smooth; minimal
cerumen noted; sensitive to sound stimuli
(CN-8: vestibulocochlear intact).
E. NOSE
Same color with the facial skin with patent
nares; septum at the midline straight and
intact; no tenderness and lesions noted; no
discharges noted.
 F. MOUTH
  Lips are intact, symmetrical, and pale in
color; with pink, pale and none inflamed moist
gums; with white patches at the midline of the
tongue; with complete set of teeth; with
dental carries noted; no dentures noted.
 G. THROAT
With full regular equal carotid pulses;
trachea at the midline; no palpable lymph
nodes and masses; no difficulty of swallowing;
good gag reflex.
 
H. CHEST AND LUNGS
With symmetrical lung expansion; chest
wall dry and intact; same color with facial skin;
breast is symmetrical in shape; with dark
brown nipples and areola; RR- 17 cpm; regular
breathing pattern; no palpable masses; no
tenderness palpated.
I. GENITO- URINARY
Genital are slightly pinkish in color; with
minimal black pubic hair; with slightly soaked
diapers and had minimal lochial discharges.
 J. SKIN EXTREMITIES
Complete digits in both hands; nails are
long and untrimmed; slightly pale nail beds;
skin was generally brown complexion; no
scars, lesions, masses; with IVF of D5LR + 10
units of oxytocin regulated at 20gtts/min.
 
 K. GENERAL CONDITION
  Conscious; febrile, slightly pale in
appearance; able to comprehend questions
given.
 ANATOMY & PHYSIOLOGY OF THE
FEMALE REPRODUCTIVE SYSTEM
 
 The reproductive role of the female is much
more complex than that of the male. Not only
must she produce the female gametes (ova),
but her body must also nurture and protect a
developing fetus during 9 months of
pregnancy.
OVARIES
Ovaries are the primary reproductive organs of a female.
The paired ovaries are pretty much the size and shape of
almonds. An internal view of the ovary reveals many tiny
saclike structures called ovarian follicles. Each follicle
consists of an immature egg, called an oocyte
surrounded by one or more layers of very different cells
called follicle cells. As a developing egg within a follicle
begins to ripen or mature, the follicle enlarges and
develops a fluid-filled central region called an antrum. At
this stage, the follicle, called a vesicular, or Graafian
follicle, is mature, and the developing egg is ready to be
ejected from the ovary, an event called ovulation.
 After ovulation, the ruptured follicle is
transformed into a very different- looking
structure called a corpus luteum, which
eventually degenerates. Ovulation generally
occurs every 28 days, but it can occur more or
less frequently in some women. In older
women, the surfaces of the ovaries are
scarred and pitted, which attests to the fact
that many eggs have been released.
The ovaries are secured to the lateral walls of the
pelvis by the suspensory ligaments. They flank the
uterus laterally and anchor to it medially by the
ovarian ligaments. In between, they are enclosed
and held in place by a fold of peritoneum, the
broad ligament.
Meiosis, the special kind of cell division in the male
testes to produce sperm, also occurs in the female
ovaries. But in this case, female gametes, or sex
cells, are produced, and the process is called
oogenesis, which means “the beginning of an egg.”
DUCT SYSTEM
The uterine tubes, uterus, and vagina form
the duct system of the female reproductive
tract.
UTERINE (FALLOPIAN) TUBES
The uterine or fallopian tubes form the
initial part of the duct system. They receive
the ovulated oocyte and provide a site where
fertilization can occur. Each of the uterine
tubes is above 10 cm (4 inches) long and
extends medially from an ovary to empty into
the superior region of the uterus. Like the
ovaries, the uterine tubes are enclosed and
supported by the board ligament.
Unlike in the male duct system, which is continuous
with the tubule system of the testes, there is little
or no actual contact between the uterine tubes is
expanded and has fingerlike projection called
fimbriae, which partially surround the ovary. As an
oocyte is expelled from an ovary during ovulation,
the waving fimbriae create fluid currents that act to
carry the oocyte into the uterine tube, where it
begins its journey toward the uterus.
A combination of peristalsis and the rhythmic
beating of cilia carry the oocyte toward the
uterus. Because the journey to the uterus takes 3
to 4 days and the oocyte is viable for up to 24
hours after ovulation, the usual site of fertilization
is the uterine tube. To reach the oocyte, the
sperm must swim upward through the vagina and
uterus to reach the uterine tubes. This is a difficult
journey. Because they must swim against the
downward current created by the cilia, it is rather
like swimming against the tide!
The fact that the uterine tubes are not
continuous distally with the ovaries places
women at risk for infectious spreading into the
peritoneal cavity from other parts of the
reproductive tract. Gonorrhea bacteria
sometimes infect the peritoneal cavity in this
way, causing an extremely severe inflammation
called pelvic inflammatory disease (PID). Unless
treated promptly, PID can cause scarring and
closure of the narrow uterine tubes, which is
one of the major causes of female infertility.
UTERUS
The Uterus, located in the pelvis between the
urinary bladder and rectum, is a hallow organ that
functions to receive, retain, and nourish a fertilized
egg. In a woman who has never been pregnant, it is
about the size and shape of a pear. (During
pregnancy, the uterus increases tremendously in
size to accommodate the growing fetus and can be
felt well above the umbilicus during the latter part
of pregnancy). The uterus is suspended in the pelvis
by the broad ligament and anchored interiorly and
posteriorly by the round and uterosacral ligaments,
respectively.
The major portion of the uterus is referred to as the
body. Its superior rounded region above the entrance of
the uterine tubes is the fundus, and its narrow outlet,
which protrudes in to the vagina below, is the cervix.
The wall of the uterus is thick and composed of three
layers. The inner layer or mucosa is the endometrium. If
fertilization occurs, the fertilized egg burrows into the
endometrium of the uterus (this process is called
implantation) and resides there for the rest of its
development. When a woman is not pregnant, the
endometrial lining sloughs off periodically, usually about
every 28 days, in response in the blood. This process is
called menses.
 Cancer of the cervix is common among
women between the ages of 30 and 50. Risk
factors include frequent cervical inflammation,
sexually transmitted disease, multiple
pregnancies, and an active sex life with many
partners. A yearly Pap smear is the single most
important diagnostic test for detecting this
slow-growing cancer.
 The myometrium is the bulky middle layer
of the uterus. It is composed of interlacing
bundles of smooth muscle. The myometrium
plays an active role during the delivery of a
baby out of the mother’s body. The outermost
serous layer of the uterus is the epimetrium
or the visceral peritoneum.
VAGINA
The vagina is a thin-walled tube 8 to 10 cm (3
to 4 inches) long. It lies between the bladder
and rectum and extends from the cervix to the
body exterior. Often called the birth canal, the
vagina provides a passageway for the delivery
of an infant and for the menstrual flow to leave
the body. Since it receives the penis (and
semen) during sexual intercourse, it is the
female organ of copulation.
 The distal end of the vagina is partially
closed by a thin fold of the mucosa called the
hymen. The hymen is very vascular and tends
to bleed when it is ruptured during the first
sexual intercourse. However, its durability
varies. In some females, it is torn during
sports activity, tampon insertion, or pelvic
examination. Occasionally, it is so tough that
it must be ruptured surgically if intercourse is
to occur.
External Genitalia
The female reproductive structures that are
located external to the vagina are the external
genitalia. The external genitalia, also called
the vulva, include the mons pubis, labia,
clitoris, urethral and vaginal orifices, and
greater vestibular glands.
The mons pubis (“mountain on the pubis”) is a fatty,
rounded area overlying the pubic symphysis. After
puberty, this area is covered with pubic hair. Running
posteriorly from the mons pubis are two elongated
hair-covered skin folds, the labia majora, which
enclose two delicate hair-free like folds, the labia
minora. The labia majora enclose a region called the
vestibule, which contains the external openings of the
urethra, followed posteriorly by that of the vagina. A
pair of mucus producing glands, the greater vestibular
glands, flanks the vagina, one on each side. Their
secretion lubricates the distal end of the vagina during
intercourse.
Just anterior to the vestibule is the clitoris, a small,
protruding structure that corresponds to the male
penis. Like the penis, it is hooded by the prepuce
and is composed of sensitive erectile tissue that
becomes swollen with blood during sexual
excitement. The clitoris differs from the penis in
that it lacks reproductive duct. The diamond-
shaped region between the anterior end of the
labial folds, the anus posteriorly, and the ischial
tuberosities laterally is the perineum.
 PATHOPHYSIOLOGY
 

Predisposing Contributing factor

factor: :
Age: 21 yrs. Old
Sex: female
-Emotional
stress
Precipitating
factor:
 DRUG STUDY
LIDOCAINE (HYDROCHLORIDE)
Lye’doe kane

DRUG CLASSES:
Antiarrhythmic
Local Anesthetic
 THERAPEUTIC ACTION:
Antiarrhythmic: decreases diastolic depolarization,
decreasing automaticity of ventricular cells,
increases ventricular fibrillation threshold.
Local Anesthetic: Blocks the generation and
conduction of action potentials in sensory
nerves by reducing sodium permeability,
reducing height and rate of the action potential,
increasing excitation threshold, and slowing
conduction velocity.
 INDICATION:
Contraindicated with allergy to lidocaine or
amide-type local anesthetics, heart failure,
cardiogenic shock, second-or third-degree
heart block.
  
ADVERSE EFFECT:
Antiarrhythmic with systemic administration
CNS: Dizziness or light headedness, fatigue,drowsiness,
unconsciousness, tremors, twitching, vision changes,
may progress to seizures.
CV: Cardiac arrhythmias, cardiac arrest, vasodilation,
hypotension.
GI: Nausea and vomiting.
Hypersensitivity: Rash, anaphylactoid reactions.
 
 
 NURSING CONSIDERATION:
ASSESSMENT
History
Allergy to lidocaine or amide-type local
anesthetics, heart failure, cardiogenic shock,
second – or third – degree heart blocks.
Wolff – Parkinson – white syndrome, strokes
adam syndrome.
 
 Physical
T; skin color, rashes, lesions, orientations,
speech, reflexes, sensation and movement
continous ECG monitoring during use as
antiarrythmic, edema; R, adrentitious sounds,
bowel sounds, liver evaluations; urine output;
serum electrolytes, LFT’s renal function tests.
 INTERVENTION:
Check drug concentration carefully; many
concentrations are available.
R educed dosage with hepatic or renal failure.
Continuously monitor response when use as
anti arrhythmic or injected as local anesthetic.
 
 
OXYTOCIN (ax i toe’sin)
Pitocin

DRUG CLASSES:
Hormone
Oxytocin
 THERAPEUTIC ACTION:
Synthetic form of an endogenous hormone
produced in the hypothalamus and stored in
the posterior pituitary; stimulates the uterus,
especially the gravid uterus just before
parturition, and causes myoepithelium of the
lacteal glands to contract, which results in milk
ejection in lactating women.
 INDICATION:
Antepartum: to initiate or improve uterine contractions to
achieve vaginal delivery; stimulation or reinforcement of
labor in selected cases of uterine inertia; management of
inevitable or incomplete abortion; second trimester
abortion.
Postpartum: to produce uterine contractions during the third
stage of labor and to control postpartum bleeding or
hemorrhage.
Lactation deficiency
Unlabeled use: to evaluate fetal distress (oxytocin challenge
test), treatment of breast engorgement.
 
 CONTRAINDICATION AND CAUTION:
Contraindicated with significant cephalopelvic
disproportion, unfavorable fetal positions or
presentations, obstetric emergencies that favor
surgical intervention, prolonged use in severe
toxemia, uterine inertia, hyportonic uterine
patterns, induction or augmentation of labor
when vaginal delivery is contraindicated, previous
cesarian section, pregnancy.
Use cautiously with renal impairment.
 ADVERSE EFFECT:
CV: cardiac arrhythmia, PVCS, hypertension, subarachnoid
hemorrhage.
 
 
NURSING CONSIDERATION:
ASSESSMENT
History
Significant cephalopelvic disportion, unfavorable fetal positions or
presentations, severe toxemia, uterine inertia, hypertonic uterine
patterns.
 
 
 Physical
Fetal heart rate ( continuous monitoring is
recommended); fetal positions; fetal – pelvic
proportions; uterine tone; timing and rate of
contractions.
INTERVENTION
Ensure fetal position and size and absence of
complications that are contraindicated with oxytocin
before therapy.

 
ASSESSME
NT

NURSING
DIAGNOSIS

PLANNING