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HISTORY COLLECTION
DEMOGRAPHIC DATA
Name of the mother: Ruma Das
Age of the mother : 21 years
Antenatal diagnosis :lower abdominal pain
Last menstrual period :23/12/22
Expected date of delivery :30/09/23
Gestational age (on admission)
Date of admission :30/09/23
Date of delivery : 30/09/23
Mode of delivery: SVD
Post natal day : 1 day
Name of the husband : Fharuk begam
Age of the husband :33 years
Language spoken : bengali
Religion : hindu
IP number :3456681

SOCIO ECONOMIC HISTORY—

Types of family: neuclear
Family member:3
No of adults :2
Total monthly income of family: 10k
Earning member of family:1
No .of children:1
Socio economic class: lower class
Education:10th pass
Occupation:house wife

FAMILY HISTORY— mothers father having diabetes mellitus since 2 years.

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FAMILY TREE—

PERSONAL HISTORY—
Nutrition- adequate
Education- 10th pass
Rest and sleep-adequate and proper. She slept for 8 hours per day
Activity – dull
Habits and hobbies- cooking
Hygiene- maintained

Menstrual history-
Menarche: 12 years
Amount :normal
Interval:28 days

Marital history- married

Contraception history- nothing significant
Drug history- nothing significant
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Elimination history- she passed 6 times bladder and 2 time bowel

PAST MEDICAL HISTORY— she had no past medical history except common cold and
cough.
PAST SURGICAL HISTORY—she had no past surgical history.

PRESENT MEDICAL HISTORY— mother was having pain and baby delivered on 30/09/23
at 6 pm,

PRESENT SURGICAL HISTORY—she has not undergone any surgical history

OBSTETRICAL HISTORY—
SI MOTHER CHILD
NO
YEAR GRAVIDA PERINA FULL ABORTI MODE REMAR SEX ALIVESTILL WEIGH REMARK
TAL TERM ON OF KS OF BORN T S
PERIOD DELIVE BABY
RY
2o23 1 39 weeks term no SVD unhealth boy alive yes 2.6kg healthy
5 days y

LMP- 23/12/22
EDD- 30/09/23
Model of delivery: SVD
Gestational age at birth (with date) – 39 weeks 7 days
Sex of the baby: boy
1st trimester- nausea, vomiting
2nd trimester- nothing significant
3rd trimester- pelvic pain
Delivery note: baby delivered at 6.pm and placenta expulsion at 6.15 pm, weight
is 2.6 kg
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PHYSICAL EXAMINATION—
VITAL SIGNS-
Temperature- 96.6 f
Pulse- 65bpm
Respiration- 24 bpm
B.P.- 100/70 mmhg
ANTHROPOMETRIC MEASUREMENTS—
Weight- 51 kg
Height- 149 cm
HEAD TO FOOT EXAMINATION—
General appearance-
Head- no infection ,no dandruff, no pedicuolosis is present
Eyes- no edema, no redness, no anemia is present
Nose- no discharge , clean nostrils.
Ears-symmetrical, no discharge is present
Mouth- no gingivitis, no somatitis is present
Neck- no enlargement is present
Chest- no abnormal sound is present
Abdomen- no gas is present
Back- normal
Extremities- nothing significant
Genitalia- discharge is present

OBSTETRIC EXAMINATION—
ABDOMEN-
Inspection- linea nigra,stria albicans is present
Palpation- fundal hight is 13 cm , uterous is bulky

BREAST EXAMINATION-
Inspection- primary and secondary areola is present, discharge is present
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Palpation- nothing significant

VAGINAL EXAMINATION-
External- discharge is present.

INVESTIGATION-
Date Investigation Mothers value NormalValue Remarks
BLOOD
Rh-grouping B positive
21/11/23 Hb 10.2 gm/dl 11-16 gm/dl Normal
RBS 129 mg/dl >140 mg/dl Normal
HIV/HBSAG - - Negative
URINE
Albumin 3.7 g/dl 3.4 -5.4 g/dl Normal
Sugar 21 mg/dl Upto 25 mg/dl normal

case

INTRODUCTION: Retained placenta is a condition in which all or part of the placenta

or membranes remain in the uterus during the third stage of labour.
Retained placenta can be broadly divided into:
1. failed separation of the placenta from the uterine lining
2. placenta separated from the uterine lining but retained within the uterus
A retained placenta is commonly a cause of postpartum haemorrhage, both primary and
secondary.
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Retained placenta is generally defined as a placenta that has not undergone placental expulsion

within 30 minutes of the baby's birth where the third stage of labor has been managed actively.

DEFINITION:

Retained placenta is generally defined as a placenta that has not undergone placental expulsion

within 30 minutes of the baby's birth where the third stage of labor has been managed actively.

ANATOMY:

This is a fetomaternal organ.

It has two components:
Fetal part-develops from the chorionic sac ( chorion frondosum)
Maternal part-derived from the endometrium (functional layer-decidua basalis)
The placenta and the umbilical cord are a transport system for substances between the mother
and the fetus.( vessels in umbilical cord)
Function Of The Placenta:
1. Protection
2. Nutrition
3. Respiration
4.Excretion
5.Hormone production
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PHYSIOLOGY

Nutritive function

■ GLUCOSE: by facilitated diffusion (GLUT 1)

LIPIDS: direct transport

■ AMINO ACIDS: active transport (ATPase)

• Water & electrolytes

Na, K, Cl-: simple diffusion

• Ca, P, Fe: active transport

• Water soluble vitamins: active transport

■ Fat soluble vitamins: transferred slowly

RESPIRATION FUNCTION
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Placenta serves as fetus's lung and allow transmission oxygen.

Fetus obtain oxygen and excrete Co2 through placenta.

Oxygen from mothers Hb passes into fetal blood by simple diffusion similarly fetus gives off
Co2 into maternal blood.

Oxygen inhale by mother diffuse into blood, then O2 reach to circulatory system of fetus through
umbilical cord.

Placenta prevent chances of inhaling amniotic fluid.

ENDOCRINE FUNCTION

• Protein Hormones

✓ Human chorionic gonadotropin

Human placental Lactogen

✓ Pregnancy Specific beta 1 glycoprotein

✓ Growth Factors

Pregnancy associated plasma protein A

ETIOLOGY
Book picture Patient picture
• Placenta separated but not expelled
• Simple Adherent Placenta
• Morbid adherence of the placenta:
 Placenta Accreta
 Placenta Increta
 Placenta Percreta
• Constriction ring-reforming cervix
• Full bladder
• Uterine abnormality
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CLINICAL MENIFESTATION

Book picture Patient picture

1. Absence of features of placental 1. Heavy vaginal bleeding after

separation depending whether it is
separated or retained.
2. Heavy vaginal bleeding after 24 hours
of Delivery. 2. 24 hours of delivery.
3. Abdominal hearines 3. Abdominal heaviner.
4. Hemorrhage
5. Shock due to blood loss.
6. Puerperal sepsis 4. Hypotension.
7. Hypotension. 5. Fushy odor of lochia.
8. Fishy odor of lochia

DIAGNOSTIC TEST

Book picture Patient picture

Non pharmalogical management: 1. Patient was watched carefully after delivery

1. To palpate the fundus and manage uterus to for expulsion of placenta
make it hard 2. Fumous was palpated.
2. Watch carefully for evidence of any
bleeding, revealed to note to the sign of
seperation of placenta. 3. Catheterization wan Done
3. The bladder should be emptied using a rubber
catheter.
4. Vaginal pack can be given to manage bleeding.
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Pharmacological management: Pharmacological management 1

Oxytocin 10 units in IM or methergine 0.2 mg Oxytocin 20 unit was administered with
in IV 1000ml Ringer Lactate solution.
2. Start crystalloid solution. NS or RL with 2. inj Pipzo 2gm was administered.
oxytocin at 60 drops/minute. 3. Inj Tranexamic acid 5ml IV, BD was
3. Give broad spectrum antibiotic. administered.
4. Inj Tranexamic acid 3 should be
administered.

COMPLICATIONS:

Book picture Patient picture

1. Hemorrhage. 1. Hypotension
2. Hypotension
3. Shock
4. Sepsis

NURSING DIAGNOSIS:

1. Fluid volume deficit related to excessive bleeding as evidenced by hypotension

2. Impaired tissue perfusion related to decrease blood circulation as evidenced by cold

extremities.

3. Imbalanced nutrition Less than body requirement related to nausea an evidenced by weakness,
tiredness
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4.Impaired gas exchange related to decrease oxygen delivery as evidenced by shortness of

breath.

5. Activity intolerance related to continuous bleeding as evidenced by not performing daily

works

NURSING MANAGEMENT:-
Nursing theorists and their work have a significant impact on nurse education and clinical
practice. They can be applied both in theoretical research and used practically in diverse interventions
aimed at the improvement of patient care quality and patient outcomes. One of the theories most
commonly employed in practice is Dorothea Orem’s Self-Care Deficit Theory of Nursing. Orem
received her nursing diploma in the 1930s and started her career at Providence Hospital School of
Nursing in Washington (Berbiglia&Banfield, 2014). In the following decades, she received her BS
and MS degrees in Nursing Education. She worked throughout the country following her goal to
improve nursing in general hospitals.

Theory application
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Mrs. Nargis begam admitted in the hospital . she was having labour pain, so she can’t do care
herself due to his condition. He needs support from others to perform daily living activities.
So, I applied Dorothea Orem’s Self-Care Deficit Theory for my patient while caring him to
improve his health status by setting the goals with both the nurse and the patient’s mutual
understanding.

According to Dorothea Orem the conceptual framework is

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SELF CARE

SELF CARE SELF CARE

AGENCY DEMANDS

NURSING
AGENCY
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In my patient’s condition the framework are as following

SELF CARE

SELF CARE CAPABILITIES Therapeutic Self

1.Poor Activity level Care demand
2.Poor Nutrition 1.Activity
3.Anorexia 2.Communication
4.Nausea,weekness 3.Self Care
5.Self care deficit 4.Nutrition
6.Risk for Bed sore 5.Skin care

NURSING CAPABILITIES
1.Improve Activity level
2.Improve Appetite,reduce nausea and
vomitting
3.Reduce Risk for bed sore
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CARE PLAN:
Assessment Nsg goa Planning Implementat Evaluati
diagnosis l ion on

SUBJECTIVE To Assess the mothers Mother Fluid

DATA: Fluid volume main condition condition was volume
mother said i tain assessed will be
Deficit related Asess the capilary maintained
am having
dizziness To excessive Flui refill Capillary refill
d checked
Bleeding as volu Assess the skin texure
Evidenced by me Skin texure and
Assess vital sign turgor is
Hypotension Leve checked
l Maintain input output
chart Vital signs was
OBJECTIVE assessed
DATA: Encourage the fluid
Hypote- intake Input output is
Nsion. maintained
Bp 1oo/50
mmhg Fluid intake is
encouraged
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Assessment Nsg goa Planning Implementat Evaluati

diagnosis l ion on

Subjective Impaired tissue To Assess the mothers Mother Tissue

data: perfusion main condition condition was perfusion
mother says related to tain assessed will be
my hands and decrease blood tissu Assess the extremities maintained
feets are cold circulation as e Extremities was
evidenced by perf Assess the vital signs assessed
cold ussi
extremities. on Assess the capillary Vital sign are
objective refill checked
data:
cold Encourage fluid intake Capillary refill
extremities was assessed
Administer iv fuid
Fluid intake
was encouraged

Rl 500 was
administered
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assessment Nsg goa Planning Implementat Evaluati

diagnosis l ion on

Subjective Imbalanced To Assess nutritional Nutritional Nutrition

data: bala pattern pattern was is balanced
nutrition Less
Mother says I nce assessed
am having than body nutri assess mothers choice
Nausea. tion of food Mothers choice
requirement
of food was
Objective related to provide high caloric assessed
data: diet
nausea an
Tiredness, High caloric
weekness evidenced by provide small and diet was
frequent diet provoded
weakness,
tiredness encourage fluid intake Small and
frequent diet
was provided

Fluid intake
was encouraged
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assessment Nsg goa Planning Implementat Evaluati

l ion on
diagnosis

Subjective .Impaired gas To Assess the breathing Breathing Gas

data: main pattern pattern was exchange
exchange
mother says I tain assessed is
cannt breath related to gas maintained
Provide fowlers or
decrease
exch semi fowlers position Fowlers
oxygen ange position was
provided
delivery as
Provide humidified
evidenced by oxygenation
Humidified
shortness of
oxygen was
breath. Provide well provided
ventilation room

Objective Well ventilation

data: room is
shortness of provided
breath
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assessment Nsg Go Planning Implementat Evaluati

al ion on
diagnosis

Subjective Activity To Assess mother activity Mothers Activity

data: impr level activity level level is
intolerance
mother says ove was assessed improved.
that ‘I cannot related to activ Assess the cause of
perform daily ity activity intolerance Cause of
continuous
works level activity
bleeding as intolerance was
Help other to perform assessed
evidenced by
small work
not performing Mother was
helped to
daily works
Never leave mother perform small
alone work

Assist mother in daily Mother was not

works left alone
Objective
data: Mother was
Cannt perform assisted in daily
daily works works
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Health education:

Diet:
 Take green leafy vegetables
 Take high caloric diet
 Take iron rich food

Medication:
 Take medicine by doctors provided
 Check the expirery date of medicine
 Don’t skip the medicine

Exercise:
 Do free hand exercise
 Take proper rest between exercises

Follow up:
 Go for follow up regularly
 If any complication will arise than immediately go for checkup
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CONCLUSION

It would appear that we have interfered with normal labour since the 16th century that we have,
in fact, ob- structed the normal mechanism by clamping the cord. thereby creating complications
such as retained placenta. postpartum haemorrhage and rhesus iso-immunization.

As retraction of uterine muscle is enhanced by oxyto-cics, it is suggested that the third stage
should be managed as follows:

1. Give Syntometrine at the birth of the anterior shoulder.

2. After delivery of the infant the cord is severed and allowed to bleed from the placental end.

3. When there is no more bleeding from the cord end. the placenta is removed by the Brandt-
Andrews manoeuvre during the next contraction.

Midwives who are not allowed to practise the Brandt- Andrews method can simply wait for the
expulsion of the placenta by the mother, which should be within 3 minutes if the placental end of
the cord is not clamped.