Saint Michael’s College of Laguna

School of Nursing and Midwifery

Old National Highway, City of Biñan Laguna

A Case Study
of Cesarean
Delivery
(Breech
Presentation)
Biñ an Doctors Hospital
(July 19, 20, 21 – June 26,27,28, 2010)

Submitted by: Zarian Evanuel G. Woo

BSN 4B
Submitted to: Ma’am Nora Ocharon
Clinical Instructor
PATIENT’S PROFILE

Name: Patient RMJ

Age: 28 years old

Gender: Female

Civil Status: Married

Nationality: Filipino

Address: 9179 J.M. Loyola Street Maduya Carmona Cavite

Religion: Roman Catholic

Date of Birth: August 02, 1981

Attending Physician: Dr. Brilliantes

Date of Admission: July 16, 2010 (5:30am)

Final Diagnosis: PUFT Cephalic in Labor with alive Baby Boy G2P2 (2002)
Previous CS on Breech Presentation

Patients’ History: chief complain: For CS

History: Patient came schedule for CS. No hypogastric pain,

Vaginal bleeding, ruptured BOW, vomiting

Physical Examination:

- Conscious and coherent

- Warm , good skin turgor
- Anecentric sclera, pink

ANATOMY AND PHYSIOLOGY

 ANATOMY AND PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM

EXTERNAL GENITALIA

Our overview of the reproductive system begins at the external genital area— or vulva—
which runs from the pubic area downward to the rectum. Two folds of fatty, fleshy tissue surround
the entrance to the vagina and the urinary opening: the labia majora, or outer folds, and the labia
minora, or inner folds, located under the labia majora. The clitoris, is a relatively short organ (less
than one inch long), shielded by a hood of flesh. When stimulated sexually, the clitoris can become
erect like a man's penis. The hymen, a thin membrane protecting the entrance of the vagina,
stretches when you insert a tampon or have intercourse.

INTERNAL REPRODUCTIVE STRUCTURE

The Vagina
The vagina is a muscular, ridged sheath connecting the external genitals to the uterus,
where the embryo grows into a fetus during pregnancy. In the reproductive process, the vagina
functions as a two-way street, accepting the penis and sperm during intercourse and roughly
nine months later, serving as the avenue of birth through which the new baby enters the
world .
The Cervix
The vagina ends at the cervix, the lower portion or neck of the uterus. Like the vagina,
the cervix has dual reproductive functions.
After intercourse, sperm ejaculated in the vagina pass through the cervix, then proceed
through the uterus to the fallopian tubes where, if a sperm encounters an ovum (egg),
conception occurs. The cervix is lined with mucus, the quality and quantity of which is governed
by monthly fluctuations in the levels of the two principle sex hormones, estrogen and
progesterone.
When estrogen levels are low, the mucus tends to be thick and sparse, which makes it
difficult for sperm to reach the fallopian tubes. But when an egg is ready for fertilization and
estrogen levels are high the mucus then becomes thin and slippery, offering a much more
friendly environment to sperm as they struggle towards their goal. (This phenomenon is
employed by birth control pills, shots and implants. One of the ways they prevent conception is
to render the cervical mucus thick, sparse, and hostile to sperm.)
Uterus
The uterus or womb is the major female reproductive organ of humans. One end, the
cervix, opens into the vagina; the other is connected on both sides to the fallopian tubes.
The uterus mostly consists of muscle, known as myometrium. Its major function is to accept a
fertilized ovum which becomes implanted into the endometrium, and derives nourishment from blood
vessels which develop exclusively for this purpose. The fertilized ovum becomes an embryo, develops
into a fetus and gestates until childbirth.
Oviducts
The Fallopian tubes or oviducts are two very fine tubes leading from the ovaries of
female mammals into the uterus.
On maturity of an ovum, the follicle and the ovary's wall rupture, allowing the ovum to
escape and enter the Fallopian tube. There it travels toward the uterus, pushed along by
movements of cilia on the inner lining of the tubes. This trip takes hours or days. If the ovum is
fertilized while in the Fallopian tube, then it normally implants in the endometrium when it
reaches the uterus, which signals the beginning of pregnancy.
Ovaries
The ovaries are the place inside the female body where ova or eggs are produced. The
process by which the ovum is released is called ovulation. The speed of ovulation is periodic
and impacts directly to the length of a menstrual cycle.
After ovulation, the ovum is captured by the oviduct, where it travelled down the
oviduct to the uterus, occasionally being fertilised on its way by an incoming sperm, leading to
pregnancy and the eventual birth of a new human being.
The Fallopian tubes are often called the oviducts and they have small hairs (cilia) to help
the egg cell travel.
INDICATIONS FOR THE PROCEDURE
CAESARIAN SECTION

A Caesarian section is a form of childbirth in which a surgical incision is made through a

mother’s abdomen and uterus to deliver one or more babies. It is usually performed when a
vaginal delivery would put the baby’s or mother’s life or health at risk; although in recent times
it has been also performed upon requests for births that would otherwise have been normal.

Caesarian section (CS) is recommended when vaginal delivery might pose a risk to the
mother or baby. Reasons for CS include:

 Precious (high risk) fetus

 Prolonged labor or failureto progress (dystocia
 Apparent fetal distress
 Apparent maternal distress
 Complications (pre-eclampsia, active herpes)
 Catastrophes such as cord prolapse or uterine rupture
 Multiple births
 Abnormal presentation (breech or transverse positions)
 Failed induction of labor
 Failed instrumental delivery
 The baby is too large (macrosomia)
 Placental problems (placenta previa, placental abruption/ placenta accrete)

 Umbilical cord abnormalities

 Contracted pelvis
 Sexually transmitted infections such as genital herpes
 Previous caesarian section
 Old age
 Breech Presentation
Breech Presentation

Most fetuses are in breech position early in pregnancy. However, by week 38

fetus normally turns to a cephalic presentation. Although the fetal head is widest
single diameter, the fetus’s buttocks (Breech), plus the legs, actually take up more
space. The fact that the fundus is the largest part of the uterus is probably the
reason why in approximately 97% of all pregnancies, the fetus turns so that the
buttock and lower extremities are in the fundus.

There are several types of breech presentation: complete, frank and footling.
Breech presentation is more hazardous to a fetus than a cephalic presentation,
because there is a higher risk of the following complications:
- Anoxia from the prolapsed cord
- Traumatic injury to the after coming head
- Fracture of the spine of arm
- Dysfunctional labor
- Early rupture of the membrane because of the poor fit of the presenting
part
The inevitable contraction of the fetal buttocks from cervical pressure often
causes meconium to be extruded into the amniotic fluid before birth. This, unlike
meconium staining that occurs due to fetal anoxia, is not a sign of fetal distress
but expected from the buttock pressure. Such meconium excretion can however,
lead to meconium aspiration if the infant inhales amniotic fluid.

LABORATORY / DIAGNOSTICS

Actual Normal Nursing

Procedure / Date Implications
Findings Findings Responsibilities
1. CBC Pre:
 Check Doctor’s
Hemoglobin 116 120 – 140 Decrease Order.
g/dL - Indicates  Inform client and
occurrence of explain the
anemia procedure.
Hematocrit 0.35 0.30 Increase  No need for NPO.
- Indicates
hypercoagulation Intra:
WBC 8.0 5 - 10 Normal  Perform blood
Segmenters 0.60 0.36 - 0.66 Normal extraction
Lymphocytes 0.14 0.22 - 0.40 Decrease (venipuncture
- Indicates high technique) using
risk for acquiring aseptic technique.
 Actual Normal Nursing
Procedure / Date Implications
Findings Findings Responsibilities
infection  Put extracted
Eosinophils 0.02 Normal blood in
Stab Cells 0.04 0.01 - 0.04 Normal ethyldiamino-
Platelets 320 0.02 - 0.05 Normal tetracetate
150 – 400x9/L (EDTA) or the
lavender top
vacuum tube.

Post:
 Label the
container properly
and correctly.
 Send specimen to
the lab
immediately.
 Document the
result to the chart
and inform
physician that the
result is out.

URINE ANALYSIS

Microscopic Exam Chemical Exam

Color: Yellow Albumin: Negative

Transparency: Hazel Sugar: Negative

pH: 6.0 (7.35 – 7.45)

Specific Gravity: 1.010 (1.010 – 1.025)

Epithelial Cells: Moderate