Normal Spontaneous Delivery

NORMAL SPONTANEOUS DELIVERY

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Involves the birth of a babyand delivery of the placentafrom the uterus and throughthe cervix and the birth canal

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MANIFESTATIONS

FatigueBreast swelling Nausea and vomiting Smell is more sensitive Amenorrhea Tenderness of the breast

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COMPLICATIONS Back pain particularly in the third

trimester Constipation due to decrease motility

secondary to elevated progesterone Dehydration caused by expanded

intravascular space and increased third spacing of fluids

Edema caused by compression of the inferior vena cava and pelvic veins by the uterus leads to increased hydrostatic pressure in lower extremities

Varicose Veins due to relaxation of the venous smooth muscle and increased intravascular pressure

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PHYSIOLOGIC CHANGESDURING PREGNANCY

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INTEGUMENTARYSYSTEM

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Striae Gravidarum

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Umbilicus protrudes as a round bump at the center of the abdominal wall

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Linea Nigra

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Melasma/ Mask of Pregnancy

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Telangiectases

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Palmar Erythema

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↑ Perspiration

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RESPIRATORYSYSTEM

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Acute sensation of shortness of breath

Vital capacity does not ↓↓ Residual volume up to 20%↑ tidal volume up to 40%↑ Total oxygen consumption by as

much as 20%Total ventilation capacity may

have risen by as much as 40% at full term

Slight ↑ in pH in serum↑ RR

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TEMPERATURE

Slightly ↑

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CARDIOVASCULARSYSTEM

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↑ Blood volume (30% to 50% or 1500mL to 3 units)

Total blood volume during pregnancy is about 5 liters

BLOOD VOLUME

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IRON, FOLIC ACID AND VITAMIN NEEDS

↑ Total need of Iron is about 800mg

↑ need for Folic Acid

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HEART

↑ cardiac output about 30%↑ HR by 10 beats per

minute

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PERIPHERAL BLOOD FLOW

During the third trimester, blood flow to the lower extremities is impaired by the pressure of the expanding uterus on veins and arteries which can lead to edema and varicosities

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SUPINE HYPOTENSION SYNDROME

↓ in blood return to the heart Can cause fetal hypoxia

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BLOOD CONSTITUTION

↑ fibrinogen about 50% Slightly ↑ Total WBC count↓ Total protein level↑ blood lipids by 1/3 ↑ cholesterol serum level by

90% to 100%

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GASTROINTESTINALSYSTEM

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Morning sickness, nausea and vomiting

Heartburn Slow intestinal peristalsis

and emptying time of the stomach

↓ gastric motility ↑ saliva formation

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URINARY SYSTEM

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FLUID RETENTION

Water is retained to aid ↑ in blood volume and to serve as a ready source of fluid for the fetus

↑ response of angiotensin renin system in the kidney

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RENAL FUNCTION

↑ urinary output (60%-80%)↓ specific gravity ↑ GFR and renal plasma flow↓ BUN Normal creatinine is to 90 to

180 mL/min to assess renal function

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URETER AND BLADDER FUNCTION

Frequent urination

↑ diameter of the ureter and bladder capacity ↑ to about 1500 mL

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SKELETAL SYSTEM

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↑ need in calcium and phosphorus Gradual softening of a woman’s

pelvic ligament and jointsWide separation of the symphisis

pubis as much as 3 to 4 mm by 32 weeks of pregnancy

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ENDOCRINE SYSTEM

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Placenta produces large amounts of estrogen, progesterone and relaxin, hCG, hPL

FSH and LH ↓ ↑ production of growth hormone and

melanocyte-stimulating hormoneOxytocin and prolactin production in

late in pregnancy ↑ thyroid and parathyroid hormone

production ↑ adrenal activity ↑ level of aldosterone ↑ production of insulin

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IMMUNE SYSTEM

↓ immunologic competency ↓igG production

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PHYSIOLOGIC CHANGESDURING LABOR

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CARDIOVASCULARSYSTEM With the ↑ cardiac output

caused by contractions during labor results in an ↑ systolic and diastolic blood pressure

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During labor, development of leukocytosis occur, or a sharp ↑ in the number of circulating WBC. At the end of labor, the average woman has a WBC count of 25,000 to 30,000 cells mm3

HEMOPOIETIC SYSTEM

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RESPIRATORY SYSTEM

↑RR to supply additional oxygen. Total oxygen consumption ↑by about 100% during the second stage of labor

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TEMPERATURE REGULATION

↑ muscular activity associated with labor can result in a slight ↑ elevation in temperature

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FLUID BALANCE

↑ sensible water loss during labor because of the ↑in rate and depth of respirations which causes moisture to be lost with each breath

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URINARY SYSTEM Kidneys begin to

concentrate urine to preserve both fluid and electrolytes. Specific gravity may ↑↓ bladder tone

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GASTROINTESTINAL SYSTEM

Inactive during labor probably because of shunting of blood to more life sustaining organs and also because of pressure on the stomach and intestines from the contracting uterus

client may experience a loose bowel movement as contractions grow strong

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NEUROLOGIC ANS SENSORY RESPONSES

Neurologic responses that occur during labor are responses r/t pain. This pain is registered at uterine and cervical nerve pelxuses. At the moment of birth, the pain is centered on the perinuem as it stretches to allow the fetus to move past it. Perineal pain is registered at S2 to S4 nerves

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GENERAL DATANAME: B.B.NAGE: 44 years oldADDRESS: Sampaloc Site 2, BF ParañaqueRELIGION: CatholicSTATUS: MarriedNATIONALITY: FilipinoOCCUPATION: Unemployed (Housewife)DATE OF BIRTH: July 13, 1967BIRTH PLACE: Bonga, Banay CapizDIALECT: Filipino, EnglishEDUCATIONAL ATTAINMENT: Highschool

Graduate

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DATE OF ADMISSION: September 3, 2011ADMITTING DIAGNOSIS: Pregnancy

Uterine 40-42 weeks Age of Gestation Cephalic in Labor, Premature Rupture of Membrane G6P5(5005)

FINAL DIAGNOSIS: Pregnancy Uterine Normal Spontaneous Delivery, Cephalic G6P6(6006)

INITIAL VITAL SIGNS:• BP: 120/80 mmHg • PR: 80 bpm • RR: 20 cpm • TEMPERATURE: 36.5 ˚C

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GENERAL DATA FOR OBCHIEF COMPLAINT: Lumbosacral PainLAST MENSTRUAL PERIOD:November 27, 2010AGE OF GESTATION: 40-41 weeksPRENATAL CARE: NoPRENATAL ILLNESS: NegativeOTHER PERTINENT ILLNESS:

(-) HPN (-) Asthma (-) DM(-) Allergy (-) Heart Disease

VITAL SIGNS:BP: 120/70 mmHg FUNDIC HEIGHT: 30 cm

PR: 76 bpm FETAL HEART TONE: 135 @ RLQ

RR: 20 cpm WEIGHT: 42 kgs

TEMPERATURE: 36.5 ˚C

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FEMALE REPRODUCTIVE SYSTEM

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EXTERNAL STRUCTURES• MONS VENERIS – pad of adipose tissue located over the symphisis pubis. It protect the junction of the pubic bone from trauma

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• LABIA MINORA – two hairless folds of connective tissue just posterior the mons veneris. Normally the folds are pink, internal surface is covered with mucous membrane and the external with skin

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• LABIA MAJORA – two folds of adipose tissue that are positioned lateral to the labia minora. It covers the genitalia and the distal urethra and vagina

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• CLITORIS – is small rounded organ of erectile tissue at the forward junction of the labia minora. It is the center of orgasm in a woman.

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• SKENE’S GLAND – or paraurethral glands; located just lateral to the urinary meatus, one on each side. Their ducts open into the urethra

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• BARTHOLIN’S GLANDS – located just lateral to the vaginal opening on both sides. Their ducts open into the distal opening. Secretions from these both glands help to lubricate the external genitalia during coitus

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• FOURCHETTE – ridge tissue formed by the posterior joining of the two labia majora. This is the structure that is sometimes cut during childbirth to enlarge the vaginal opening

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•HYMEN – tough but elastic semicircle of tissue that covers the opening to the vagina in childhood

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INTERNAL STRUCTURES• OVARIES – approx. 4cm long by 3cm in diameter and approx. 1.5cm thick . It produce mature and discharge ova and produce estrogen and progesterone and initiate and regulate menstrual cycle

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• FALLOPIAN TUBES – arise from each upper corner of the uterine body. Approximately 10cm long. Their function is to convey the ovum from the ovaries to the uterus and to provide a place for fertilization of the ovum

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• FOUR SEPARATE PARTS OF FALLOPIAN TUBES:1. INTERSTITIAL – lies within the uterine wall. Only about 1cm in length. The lumen of the tube is only 1mm in diameter at this point

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2. ISTHMUS – approx. 2cm in length and extremely narrow. It is cut or sealed in a tubal ligation, or tubal sterilization procedure

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3. AMPULLA – longest portion of the tube. Approximately 5cm in length. It is in this portion that fertilization of an ovum usually occurs

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4. INFUNDIBULAR – approximately 2cm long and is funnel shaped. The rim of the funnel is covered by fimbria that help to guide the ovum into the fallopian tube

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• UTERUS – hollow, muscular, pear-shaped organ located in the lower pelvis, posterior to the bladder and anterior to the rectum.

• 3 DIVISIONS:1. Body2. Isthmus3. Cervix

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• CERVICAL CANAL – central cavity• INTERNAL CERVICAL OS – opening of the canal at the junction of the cervix and isthmus• EXTERNAL CERVICAL OS – distal opening to the vagina. The level is at the level of ischial spine.

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ULTRASOUND

• JUNE 27, 2011IMPRESSION:

Single, live, intrauterine pregnancy of about 30 weeks 2 days Age of GestationNormal placental localization

Cephalic presentation.