Iloilo Doctors' College.

West Avenue Timawa Molo, Iloilo City

PRESENTATION
Presented by: BSN 2F Group 3
Presented to: Ms. Mary Ann Salamisan
AIRA JADE MONDEJAR RUSSLIE ANN PERSONA KENREI ORTEGA
CHARLENE MONDAYA RYA LEGO LARROZA ARRIANNE NADINE
PATOPATEN
HEATHER LOUISE LIANDA NES SALCEDO
RHOSHIELL KATE MOGOTE DIANE PADURA
 I. Introduction
The term “labor” refers to a period of time during which the
cervix gradually dilates and effaces due to regular, painful
uterine contractions. The World Health Organization (WHO)
described a normal birth as “spontaneous in onset, low-risk
at the outset of labor and delivery, the newborn is born
spontaneously in the vertex position between 37 and 42
completed weeks of pregnancy, and mother and infant are
in good condition following delivery.”
 I. Introduction
In spite of the considerable debates and research that have been ongoing
for several years, the concept of “normality” in labour and childbirth is not
universal or standardized. There has been a substantial increase over the
last two decades in the application of a range of labour practices to
initiate, accelerate, terminate, regulate or monitor the physiological
process of labour, with the aim of improving outcomes for women and
babies. This increasing medicalization of childbirth processes tends to
undermine the woman’s own capability to give birth and negatively
impacts her childbirth experience. In addition, the increasing use of labor
interventions in the absence of clear indications continues to widen the
health equity gap between high- and low-resource settings.
 I. Introduction
This guideline addresses these issues by identifying the most
common practices used throughout labour to establish norms of
good practice for the conduct of uncomplicated labour and
childbirth. It elevates the concept of experience of care as a critical
aspect of ensuring high-quality labour and childbirth care and
improved woman-centred outcomes, and not just complementary to
provision of routine clinical practices. It is relevant to all healthy
pregnant women and their babies, and takes into account that
childbirth is a physiological process that can be accomplished
without complications for the majority of women and babies.
 II. Objectives
General Objective:

At the end of the case presentation the participants and

audience will be able to understand the process of
laboring and delivery of an intrapartum patient. And it's
nursing management and aquire the proper knowlege, skills
and attitude in providing care.
 II. Objectives
Specific Objective:

Knowledge:
1. Able to know the characteristics of True and False labor
2. Initial assessment of laboring patient
3 . Can Identify the stages and mechanism of normal labor and delivery.
4 . Techniques to evaluate the progress of labor
5. Pain management during labor
6. Methods of monitoring the mother and fetus
7. Management of normal delivery
 II. Objectives
Specific Objective:
Skills
1. Assessing the general condition of the patient.
2. Record and document the data properly of the clients' condition.
3. Implement a nursing care plan for managing intrapartum patients using the nursing process

Attitude
1. Recognize and acknowledge patients' needs and concerns with empathy.
2. Establish rapport with the client to be able to earn trust and build a therapeutic relationship
3. Provide emotional support, physical comfort measures, an objective viewpoint and
assistance to the patient..
 III. Nursing Health
History

A. Biographic Data Source of information:

Client/Patient
Patient name: Andrea R. Attending Physician: Dr. Unknown
Address: N/A Date of Admission: N/A
Age: 22-year-old Time of Admission: N/A
Sex: Female Chief complaint: Abdominal pains
Marital Status: Single with cramping extending to her
Occupation: College Graduate lower back.
Religion: N/A Admitting Impression: Pain
 III. Nursing Health
History
B. Chief Complaint

Abdominal pains with cramping extending to her lower back.

C. History of present illness

Andrea R. is having labor pain. Vital signs were taken with the following results:
Temperature=37.1°C, Pulse Rate=88 bpm, Respiratory Rate= 20
cpm, Blood Pressure=130/80 mmHg. After a few hours, Andrea R. was
transferred to the delivery room and confirmed to deliver a baby.

 III. Nursing Health

History
D. Past Medical History

During her late trimester, Andrea R. do not have any signs of vaginal
bleeding, vomiting and nausea. She suffers from backache painless
contraction and constipitation. There is an increase in vaginal
secretions and feels to lose her breath when moving.

 IV. Physical Examination

Vital Signs
Temperature=37.1°C
Pulse Rate=88 bpm
Respiratory Rate= 20cpm
Blood Pressure=130/80 mm
Inspection:

•Experiencing abdominal pains with

cramping extending to her lower back

 IV. Physical Examination

Inspection:
•Internal vaginal examination:
-Cervix is dilated at 3cm, 50% effaced, with fetal head at (-3) station and
membranes are intact.
-Uterine contractions: moderate to strong in intensity that are lasting for 30-40
seconds and usually occurring every 4-5 minutes.
•Internal examination:
-Cervix is 7 cm dilated
-70%effaced with the fetal head at (0) station.
-Duration of contractions: already occurring for 60-70 seconds, with intervals
of approximately 2 minutes apart
-placed on NPO while in active labor.
 IV. Physical Examination

Inspection:
•While contractions are occurring, Andrea was complaining that the
pain intensity is increasing.
•Bag of water ruptured and bloody show was flowing out from her
vagina to her thighs.
- She complaints of the urge of bearing down during this time.
• Internal examination:
- revealed a full 10 cm.
- cervical dilatation with the fetal head at (+3) station.
 IV. Physical Examination

Palpation:

•The fetus is in cephalic presentation by

Leopold’s Maneuver and as revealed in
ultrasound result.
•Bladder is distended.
 IV. Physical Examination

Auscultation:
•Fetal assessment:
-Fetal heart tones heard by
stethoscope on the left lower
abdominal quadrant at 140 beats per
minute.
 V. Anatomy and
Physiological
What does the reproductive system do?

The reproductive system is a collection of organs and

a network of hormone production in men and women
that enable a man to impregnate a woman who gives
birth to a child. During conception, a sperm cell from
the man fuses with an egg cell in the woman, creating
a fertilized egg (embryo) that implants and grows in
the uterus during pregnancy.

 V. Anatomy and
Physiological
Abnormalities or damage to reproductive organs and malfunction
of the hormone production and delivery system that governs
reproduction are common causes of infertility in men and women.

Key functions & parts of the female reproductive system

The female reproductive system is designed to:
Produce the eggs necessary for reproduction, called the ova
(ovum is singular for one egg) or oocytes
Incubate and nourish a fertilized egg until it is fully developed
Produce female sex hormones that maintain the reproductive
cycle

 V. Anatomy and
Physiological
The female reproductive organs
include:
Ovaries — The ovaries are two
small, oval-shaped glands
located on either side of the
uterus. They are home to the
female sex cells, called eggs, and
they also produce estrogen, the
female sex hormone.

 V. Anatomy and
Physiological

Fallopian tubes — The fallopian

tubes are narrow tunnels for a
fertilized egg to make its way down
to the uterus. Damage or blockage to
the fallopian tubes — called tubal
disease — can sometimes cause
fertility problems. Learn more about
common fertility problems.
 V. Anatomy and
Physiological
Uterus — The uterus is a hollow, pear-shaped organ
located in a woman’s lower abdomen, between the

bladder and the rectum. It is also called the “womb”

and holds the fetus during pregnancy. Each month,
the uterus develops a lining (the endometrium) that
is rich in nutrients. The reproductive purpose of this
lining is to provide nourishment for a developing
fetus. Uterine abnormalities, such as fibroids or
endometriosis, may cause infertility by interfering
with egg fertilization or embryo implantation and
development.
 V. Anatomy and
Physiological
Cervix —
The cervix is the lower, narrow part of the
uterus, located between the bladder and
rectum. It forms a canal that opens to the
vagina. Often called the neck or entrance to
the womb, the cervix lets menstrual blood
out and semen into the uterus. Growths in
the cervix called polyps can sometimes
affect the fertilization of the embryo growth
process.

 V. Anatomy and
Physiological
Vagina

The vagina, also known as

the birth canal, joins the

cervix (the lower part of the
uterus) to the outside of the
body.
 V. Anatomy and
Physiological
Vulva

This is the
external portion
of the female
genital organs.

 V. Anatomy and
Physiological
Fetal development: The 3rd trimester

Fetal development continues during the third

trimester. Your baby will open his or her eyes,
gain more weight, and prepare for delivery.

 V. Anatomy and
Physiological
Week 28: Baby's eyes partially open.
Twenty-eight weeks into your pregnancy, or 26
weeks after conception, your baby's eyelids can
partially open and eyelashes have formed. The
central nervous system can direct rhythmic
breathing movements and control body
temperature.
 V. Anatomy and
Physiological
Week 29: Baby kicks and
stretches
Twenty-nine weeks into your
pregnancy, or 27 weeks after
conception, your baby can kick,
stretch and make grasping
movements
 V. Anatomy and
Physiological
Week 30: Baby's hair grows
Thirty weeks into your pregnancy, or 28 weeks after
conception, your baby's eyes can open wide. Your
baby might have a good head of hair by this week.
Red blood cells are forming in your baby's bone
marrow.
 V. Anatomy and
Physiological
Week 31: Baby's rapid weight gain begins
Thirty-one weeks into your pregnancy, or 29
weeks after conception, your baby has
finished most of his or her major
development. Now it's time to gain weight —
quick
 V. Anatomy and
Physiological
Week 32: Baby practices breathing
Thirty-two weeks into your pregnancy, or 30
weeks after conception, your baby's toenails are
visible. The layer of soft, downy hair that has
covered your baby's skin for the past few months
(lanugo) starts to fall off this week.
 V. Anatomy and
Physiological
Week 33: Baby detects light
Thirty-three weeks into your
pregnancy, or 31 weeks after
conception, your baby's pupils can
change size in response to a stimulus
caused by light. His or her bones are
hardening. However, the skull remains
soft and flexible.
 V. Anatomy and
Physiological
Week 34: Baby's fingernails grow
Thirty-four weeks into your pregnancy, or
32 weeks after conception, your baby's
fingernails have reached his or her
fingertips.
 V. Anatomy and
Physiological

Week 35: Baby's skin is smooth

Thirty-five weeks into your pregnancy, or 33
weeks after conception, your baby's skin is
becoming smooth. His or her limbs have a
chubby appearance.
 V. Anatomy and
Physiological
Week 36: Baby takes up most of the
amniotic sac
Thirty-six weeks into your pregnancy, or 34
weeks after conception, the crowded conditions
inside your uterus might make it harder for your
baby to give you a punch. However, you'll
probably still feel lots of stretches, rolls and
wiggles
 V. Anatomy and
Physiological
Week 37: Baby might turn head down
Thirty-seven weeks into your pregnancy, or 35 weeks
after conception, your baby has a firm grasp. To
prepare for birth, your baby's head might start
descending into your pelvis. If your baby isn't head
down, your health care provider will talk to you
about ways to deal with this issue.
 V. Anatomy and
Physiological
Week 38: Baby's toenails grow
Thirty-eight weeks into your pregnancy, or 36
weeks after conception, the circumference of
your baby's head and abdomen are about the
same. Your baby's toenails have reached the
tips of his or her toes. Your baby has mostly
shed all of his or her lanugo.
 V. Anatomy and
Physiological
Week 39: Baby's chest is prominent
Thirty-nine weeks into your pregnancy, or 37 weeks
after conception, your baby's chest is becoming
more prominent. For boys, the testes continue to
descend into the scrotum. Fat is being added all
over your baby's body to keep him or her warm
after birth.
 V. Anatomy and
Physiological
Week 40: Your due date arrives
Forty weeks into your pregnancy, or 38 weeks after
conception, your baby might have a crown-to-rump length
of around 14 inches (360 millimeters) and weigh 7 1/2
pounds (3,400 grams). Remember, however, that healthy
babies come in different sizes. Don't be alarmed if your due
date comes and goes with no signs of labor starting.

 V. Anatomy and
Physiological
Your due date is simply a
calculated estimate of when
your pregnancy will be 40
weeks. It does not estimate
when your baby will arrive. It's
normal to give birth before or
after your due date
VI. Diagnostic and Laboratory
Examination Result Abnormal Effects Normal Values

Complete Blood HGB: The presence of abnormal

Pregnant: >110 g/L
Count (CBC) Normal 142 g/L hemoglobin in red blood cells leads
to the cardinal features of disease,
chronic hemolytic anemia and
recurrent painful episodes.

HCT: A lower than normal hematocrit can Pregnant: >0.33 (>33%)

Normal 0.4Vol.FR indicate: An insufficient supply of
healthy red blood cells (anemia) A
large number of white blood cells
due to long-term illness, infection
or a white blood cell disorder such
as leukemia or lymphoma. Vitamin
or mineral deficiencies.
VI. Diagnostic and Laboratory
Examination Result Abnormal Effects Normal Values

Complete Blood RBC: People with anemia may have red blood
MCV: 82-98 fL
Count (CBC) Abnormal cells that have an abnormal shape or
MCH: 0.40-0.53 fmol/cell
4.41x10ͮ^12/L that look normal, larger than normal, or
MCHC: 320-360 g/L
smaller than normal. Symptoms of Reticulocyte Count:
anemia include tiredness, fast heart 0.005 -0.015
rate, pale skin, feeling cold, and, in
severe cases, heart failure.

Symptoms of white blood cell Adult; 5.o0-10x10^9 cells/L

WBC:
conditions, where you may have a count
≤
Child:( 2 years old):
Abnormal 6.2-17x10^9 cells/L
6.4 x 10^g/L that is too high or too low include: Newborn:
9.0-30x10^9 cells/L
Fever, body aches and chills.
Critical values:
2.0-40 x10^9 cells/L
VI. Diagnostic and Laboratory
Examination Result Abnormal Effects Normal Values

Physical Properties: Abnormal urine color and transparency

URINALYSIS Color: Straw may be caused by infection, disease, Color: Pale yellow
Transparency:Hazy to amber
medicines, or food you eat. Cloudy or
Reaction: milky urine is a sign of a urinary tract Appearance:
5.0(acidic) clear to slightly hazy
infection, which may also cause a bad
Specific Gravity:

smell. Milky urine may also be caused Specific gravity:

1.025
by bacteria, crystals, fat, white or red 1.005 to 1.025 with a
blood cells, or mucus in the urine. normal fluid intake

pH (reaction): 4.5 to 8
If a person has a high urine
pH/reaction, meaning that it is more
alkaline, it might signal a medical
condition, such as: kidney stones.
urinary tract infections (UTIs) kidney-
related disorders.
VI. Diagnostic and Laboratory
Examination Result Abnormal Effects Normal Values

Chemical Test Since sugar in urine indicates Glucose; Negative

URINALYSIS conditions like diabetes, kidney
Sugar; Negative Ketones: Negative
disease, and hereditary abnormalities,
Blood; Negative
sugar in urine demands immediate
Protein; Negative
and urgent medical attention.
Bilirubin: Negative
If your test shows high levels of Nitrate for bacteria:
Albumin;
urine albumin, or a rise in urine Negative
Negative
albumin, it could mean you have
kidney damage or disease. If you
have diabetes, one possible cause of
an increased urine albumin is kidney
disease (diabetic nephropathy).
VI. Diagnostic and Laboratory
Examination Result Abnormal Effects Normal Values

Microscopic Increased number of pus cells may Casts: negative,

URINALYSIS Findings reveal some destructive or healing occasional hyaline
process in the urinary tract, anywhere
Pus cells: casts
Occasional 0.3 from kidney to the bladder. It usually
Red blood cells:
is taken as indicative of an infection.
negative or rare
Epithelial cells:
A higher than normal number of RBCs few; hyaline casts:
RBC:
in the urine may be due to: Bladder, 0-1/lpf
Occasional 2-4
kidney, or urinary tract cancer.
Kidney and other urinary tract
problems, such as infection, or stones.
VI. Diagnostic and Laboratory
Examination Result Abnormal Effects Normal Values

Biometric “Intrauterine growth restriction

Ultrasound Measurements is one of the most common and
(Biometry) complex problems in modern
obstetrics. Diagnosis and
Report BPD (Biparietal
management are complicated by
Diameter): 9.13 the use of ambiguous
cm terminology and a lack of
uniform diagnostic criteria……
Size alone is not an indication
of a complication. As a result of
HC (Head this confusion, underintervention
Circumference and overintervention can
occur.”
): 32.54 cm
VI. Diagnostic and Laboratory
Examination Result Abnormal Effects Normal Values

Biometric “Intrauterine growth restriction

Ultrasound Measurements is one of the most common and
(Biometry) Fetal Number:
complex problems in modern
obstetrics. Diagnosis and
Report Single management are complicated by
the use of ambiguous
FHB: 138 bpm terminology and a lack of
uniform diagnostic criteria……
Presentation: Size alone is not an indication
Cephalic of a complication. As a result of
this confusion, underintervention
Gender: Male and overintervention can
occur.”
VI. Diagnostic and Laboratory
Examination Result Abnormal Effects Normal Values

Placenta
Ultrasound
(Biometry)
Location:
Report Posteriolateral,
left, high-lying

Estimated
Weight: 3108
grams
VI. Diagnostic and Laboratory
Examination Result Abnormal Effects Normal Values

Placenta
Ultrasound There is an increased risk of A total score of 10 out of
vaginal bleeding at the 10 or 8 out of 10 with
(Biometry)
Amniotic Fluid Index: beginning of the first normal fluid is considered
Report 4.95 cm 3.23 cmg trimester and also a risk of normal.
premature rupture of the
membranes, preterm
delivery, placental
insufficiency, and placental
Total AFI: abruption
17.39
3.74 cm
5.47 cm
VI. Diagnostic and Laboratory
Examination Result Abnormal Effects Normal Values

Biophysical Profile
Ultrasound Score A score of 6 is considered
equivocal, and a score of 4
(Biometry)
Fetal movements: 2 or less is abnormal
Report

Fetal breathing:2
A score of 6 is considered
equivocal, and a score of 4
or less is abnormal
Fetal tone: 2

Amniotic Fluid: 2
VI. Diagnostic and Laboratory
Examination Result Abnormal Effects Normal Values

Biophysical Profile
NORMAL
Ultrasound Score

(Biometry) The fetal heart rate of the

Report Average Age by fetus is normal at average
Ultrasound: age of 37 weeks and 6 days of
37 weeks, 6 days gestation

NORMAL
Expected Date of

Confinement:
The position of the fetus is
March 22, 2023
normal at average age of 37
weeks and 6 days of gestation
VI. Diagnostic and Laboratory

IMPRESSION:

Single, Live, Intrauterine Pregnancy in Cephalic

Presentation. Estimated Gestational Age is 37 weeks and 6
days based on BPD, HC, AC and FL. Posterior Placenta, Grade
1 Maturity. Normohydramnios. Biophysical Profile of 8/8.
VI. Diagnostic and Laboratory
Complete Blood Count or CBC: A full blood count, also known as a
complete blood count, is a series of medical laboratory tests that
provide information about the cells in a person's blood. The CBC
measures white blood cell, red blood cell, and platelet counts, as well
as hemoglobin concentration and hematocrit.

URINALYSIS- Urine testing give your doctor or midwife information

about important details regarding illnesses or problems that may
affect you or your developing child. Therefore, at each prenatal
appointment, as part of your routine examination, you will be required
to provide a urine sample. This sample is intended to assess whether
you have diabetes, renal disease, or any other condition. The amount
of sugar, protein, bacteria, or other substances in your urine can be
used to diagnose a bladder infection.
VI. Diagnostic and Laboratory
ULTRASOUND - An examination of the vagina, uterus, fallopian tubes,
ovaries, and bladder Sound waves are bounced off organs inside the
pelvis by an instrument inserted into the vagina.

AMNIOTIC FLUID INDEX- Using the accepted evaluation method, an

amniotic fluid index of the normal range is between 5 and 25 cm.
Oligohydramnios, or less than 5 cm, and polyhydramnios, or more
than 25 cm, are both medical terms. Oligohydramnios is when you
have too little amniotic fluid. Amniotic fluid is the fluid that surrounds
your baby in your uterus (womb). It's very important for your baby's
development. Oligohydramnios is caused by the mother's water
breaking too early. It can also be from staying pregnant past your due
date.
VI. Diagnostic and Laboratory
Meanwhile, Polyhydramnios is where there is too much amniotic
fluid around the baby during pregnancy. Amniotic fluid is the fluid
that surrounds your baby in the womb. Polyhydramnios can cause
twin or multiple pregnancies, diabetes in the mother including
diabetes caused by pregnancy (gestational diabetes), a blockage in
the baby's gut (gut atresia), an infection during pregnancy, the
baby's blood cells being attacked by the mother's blood cells
(rhesus disease) and your baby having a genetic condition
VII. Drug Study
VII. Drug Study
VII. Drug Study
VIII. Nursing Care Plan
VIII. Nursing Care Plan
VIII. Nursing Care Plan
VIII. Nursing Care Plan
IX. Discharge Plan/Health
Teaching
Discharge Plan Health Instructions
What Is the Difference Between True and False Labor?
.
Contractions may stop in false labor if you walk, rest, or
charge positions.
True labor occurs when contractions continue to occur
despite movement or position change.