clinical cases of normal labour - by sara khalid memon
TRANSCRIPT
A 28 year old female, gravida 3 ; para 2+0, has presented in OPD with back ache which increases on walking since 10 hours with mild abdominal contractions
Her LMP is 23/6/14 Her EDD is 30/3/15Gestational age: 38 weeksMarried since: 4 yearsMOD of Last baby: NVD1st, 2nd and 3rd trimesters with no any abnormal complains and normal ultrasonic scans.
Gynecological History:Had regular menstrual cycles since menarche and is suffering from gestational amenorrhea since 9 monthsNo Pap smear done and contraception never taken !
Patient is Vitally stable !
CASE SCENARIO # 01
OBSTETRICAL EXAMINATION
On P/A
SFH: 37 cm
LIE: Longitudinal
PRESENTATION: Cephalic
No. of FIFTHS PALPABLE: 5/5
CONTRACTIONS: Less than
1/10mins(with each
contraction lasting for 5 sec)
FHR: 130 beats/min
On P/V
Vulva and Vagina: NormalCervical dilation: 1cmEffacement: 20%Presenting part (station): -3Pelvis: Adequate
Patient comes with moderate pains after 6 hrs with increase in frequency of pains
On doing P/A examination
SFH: 36 cmLIE: LongitudinalPRESENTATION: CephalicNo. of FIFTHS PALPABLE: 4/5CONTRACTIONS: 2/10mins(with each contraction lasting for <20 seconds)FHR: 140 beats/min
On doing P/V examination
Cervical dilatation : 4cmMembranes : IntactStation: -2Effacement: 60%
NEXT VISIT/EXAMINATION
Fetal heart rate monitoring every half hourly.
Uterine contractions are recorded every half hourly.
Vaginal examination for checking dilatation, colour of liqour and moulding is checked after every 4 hour.
PA : descend is checked after every 4 hour.
Maternal BP is checked every 4 hourly.
Pulse of mother is checked every half hourly.
FREQUENCY OF OBSERVATIONS
• 3/5 head on P/A
• 5cm dilated cervix
• Membranes ruptured spontaneously
• Uterine Contractions 3 in 10 minutes which are mild .
AFTER 4 HRS PARTOGRAPH
Reassess the patient
Empty bladder
Hydrate her
Encourage upright
position
Encourage walking
Monitor intensively
YELLOW ZONE ??
SYNTOCINON
PASSENGER PARAMETER
PASSAGE PARAMETER
POWER PARAMETER
SYNTOCINON
Delivered a baby at
2:15pm ! Alive baby
girl, healthy, with
apgar score of 10