NORMAL SPONTANEOUS DELIVERY

Involves the birth of a baby and delivery of the placenta from the uterus and through the cervix and the birth canal

MANIFESTATIONS
Fatigue

Breast 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

PHYSIOLOGIC CHANGES DURING PREGNANCY

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INTEGUMENTARY SYSTEM

 Striae Gravidarum

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

Linea Nigra

Melasma/ Mask of Pregnancy

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Telangiectases

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Palmar Erythema

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 Perspiration

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RESPIRATORY SYSTEM

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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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CARDIOVASCULAR SYSTEM

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

BLOOD VOLUME

Total blood volume during pregnancy is about 5 liters

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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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 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

PERIPHERAL BLOOD FLOW

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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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GASTROINTESTINAL SYSTEM

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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 womans pelvic ligament and joints Wide 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 hormone Oxytocin 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 CHANGES DURING LABOR

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CARDIOVASCULAR SYSTEM
With the cardiac output caused by contractions during labor results in an systolic and diastolic blood pressure

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HEMOPOIETIC SYSTEM
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
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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 DATA
NAME: B.B.N AGE: 44 years old ADDRESS: Sampaloc Site 2, BF Paraaque RELIGION: Catholic STATUS: Married NATIONALITY: Filipino OCCUPATION: Unemployed (Housewife) DATE OF BIRTH: July 13, 1967 BIRTH PLACE: Bonga, Banay Capiz DIALECT: Filipino, English EDUCATIONAL ATTAINMENT: Highschool Graduate

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DATE OF ADMISSION: September 3, 2011 ADMITTING 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 OB

CHIEF COMPLAINT: Lumbosacral Pain LAST MENSTRUAL PERIOD: November 27, 2010 AGE OF GESTATION: 40-41 weeks PRENATAL CARE: No PRENATAL ILLNESS: Negative OTHER 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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 SKENES 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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 BARTHOLINS 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 53

 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 54 opening

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 58 tube is only 1mm in diameter at this point

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. Body 2. Isthmus 3. 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. 63

ULTRASOUND
JUNE 27, 2011
IMPRESSION: Single, live, intrauterine pregnancy of about 30 weeks 2 days Age of Gestation Normal placental localization Cephalic presentation.

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