LABOR AND DELIERY CLINICAL CASE STUDY 1

Labor and Delivery Clinical Case Study

(Student’s Name)

(Institutional Affiliation)
 LABOR AND DELIERY CLINICAL CASE STUDY 2

Labor and Delivery Clinical Case Study

Clinical Areas, Antepartum, Triage for OB, Lactation,

Student Name: ______________ Clinical Date: _______________

The purpose of this exercise is: To develop the student’s knowledge and expertise. Analysis

of assessment data to identify problems. Formulate goals/outcomes. Each section should

have at least one concise paragraph. Please provide a complete answer to all of the

questions below. Please submit all documents in Word format.

1. Chief complaint (Why did the patient present to labor and delivery?) Provide

pathophysiology on the patient’s chief complaint. Gestational age ____________

Gravida__8_____ Term _______Preterm __Not provided ____Abortions_____

Living____5__

The chief complaint was a 34-year-old woman presented to labor and delivery for a

natural birth or vaginal delivery with a 6cm dilated cervix. The pathophysiology during

pregnancy involves dilation and effacement of the cervix due to changes to expand the birth

canal to allow the fetus to pass. The dilation of the cervix must reach 10cm, which is the total

capacity to enable the fetus to pass through the vagina (Evbuomwan & Chowdhury, 2020/. The

gestational age, term, preterm, and abortion are not provided. However, she is a gravida eight

and para five, meaning she has had eight pregnancies with five live births.

2. List the top 2 priorities for this client below and indicate why you chose this order of

importance after each priority (You may include the fetus as a patient).
 LABOR AND DELIERY CLINICAL CASE STUDY 3

Preventing bleeding in the patient is the priority. Due to her previous pregnancies, the

patient is at risk of experiencing postpartum hemorrhage, also contributed to by the number of

prior pregnancies. As a result, the aim is to prevent more bleeding by adopting the safe limits

aspect. Secondly, ensuring the baby and mother were safe during labor and delivery was

necessary (ACOG, 2020). This was done by achieving adequate maternal and fetal perfusion that

would prevent excessive bleeding by the mother and avoid fetal distress during delivery.

What is the patient’s goal for each priority using the SMART acronym? State whether the

goal was met. If not, how did you reformulate the goal so it could be attained? Plans can

include those for the fetus.

Based on the priority, the goal for the patient was to prevent the patient’s vaginal blood

loss from exceeding 500 ml. This goal was not met because the patient lost 600ml of blood.

Therefore, attaining this goal required putting the patient under continuous hemodynamic

monitoring and administering prophylactic measures such as methergine after delivering the

baby (Almutairi, 2021). For the second priority, the goal was to have the mother undergo

successful natural delivery without any complications. This goal was met successfully because

the mother opted to undergo an epidural which relieved her pain, and she had an uncomplicated

vaginal delivery.

List your most important intervention for each goal and state your rationale using an

evidence-based reference to explain your intervention(s) with an explanation.

For the first goal, the intervention would be methergine administration which has been

proven effective in controlling bleeding, just as was prescribed by the doctor. The medication is

an uterotonic agent capable of stimulating uterine contractions and reducing bleeding by

 LABOR AND DELIERY CLINICAL CASE STUDY 4

enhancing uterine contractions. As a result, methergine is effective in preventing postpartum

hemorrhage (Vallera et al., 2017). For the second goal, the intervention would be providing the

patient with emotional support and offering reassurance and comfort measures to achieve

relaxation and cope effectively during labor. This can also be achieved through continuous

monitoring of the fetal heart rate, dilation of the cervix, and observing maternal vital signs. These

are important in reducing pain and lowering anxiety, promoting the mother and baby’s well-

being, and encouraging positive progress during labor.

3. What were the most critical education points you taught this client during your shift

regarding her care and why.

Health education is very critical for the patient. This included informing the patient on

the signs and symptoms of postpartum hemorrhage and the need to immediately notify the

healthcare provider when such signs and symptoms are noticed. This also included what she

should do in case of excessive bleeding (Afshar et al., 2017). Secondly, the patient was educated

on the significance of monitoring fetal movement and informing the healthcare provider of any

fetal activity changes. The patient was also informed about possible assisted vaginal delivery and

when a cesarean section is necessary. Finally, the patient was educated o the criticality of good

nutrition and hydration during breastfeeding.

4. What environmental barriers/factors contributed to the diagnosis for this patient (if on

antepartum)? Think about what factors led to early admission as opposed to going to a

normal full-term pregnancy.

Environmental factors can contribute to admitting the patient earlier in the hospital.

These included the patient’s history of many pregnancies, which increased her risk of
 LABOR AND DELIERY CLINICAL CASE STUDY 5

experiencing a complicated delivery (Vogel et al., 2018). Also, the healthcare provider’s decision

for induced labor due to considering potential complications would have led to early admission.

5. List 3 Quality Indicators (Core Measures, National Patient Safety Goals, or QSEN) did

you see applied or did you facilitate the clinical agency in accomplishing today?

The quality indicators that were used in the situation included the use of fetal heart rate

monitoring to determine the fetus’s well-being and detect the presence of any signs of fetal

distress. The second one was administering methergine to prevent postpartum hemorrhage and

avoid excessive blood loss (Vallera et al., 2017). Finally, the team ensured adequate and

effective communication and documentation of the patient’s vital signs and cervical dilation to

detect and prevent any complications.

6. How did you incorporate evidence-based practices in your patient care?

Evidence-based practice is very significant in the treatment and handling of patients. This

case included monitoring the fetal heart rate continuously and administering methergine, an

uterotonic medication, to prevent and manage postpartum hemorrhage. Performing proper

diagnosis and proper positioning of the mother during labor and early introduction of the baby to

breastfeeding ensured the reduced risk of postpartum hemorrhage, stimulated uterine

contractions, amd promoted bonding (ACOG, 2020). They ensured complications were

prevented.

7. Describe how you evaluated and measured the effectiveness of your teaching with the

patient and family today.

Assessing and evaluating the effectiveness of the teaching offered to the patient was done

by asking the patient to recall and repeat the significant points discussed during the education
 LABOR AND DELIERY CLINICAL CASE STUDY 6

session. Moreover, the questions raised by the patient were appropriately responded to,

culminating in providing some more literary materials and resources as reinforcement to the

previously offered information (ACOG, 2020). The family also joined to help ensure all the

points sunk in and the patient had an effective care plan.

 LABOR AND DELIERY CLINICAL CASE STUDY 7

References

ACOG. (2020). Prepregnancy Counseling. ACOG. https://www.acog.org/clinical/clinical-

guidance/committee-opinion/articles/2019/01/prepregnancy-counseling

Afshar, Y., Wang, E. T., Mei, J., Esakoff, T. F., Pisarska, M. D., & Gregory, K. D. (2017).

Childbirth Education Class and Birth Plans are Associated with a Vaginal

Delivery. Birth, 44(1), 29-34. https://doi.org/10.1111/birt.12263

Almutairi, W. M. (2021, May). Literature Review: Physiological Management for Preventing

Postpartum Hemorrhage. In Healthcare (Vol. 9, No. 6, p. 658). MDPI.

https://doi.org/10.3390/healthcare9060658

Evbuomwan, O., & Chowdhury, Y. S. (2020). Physiology, Cervical Dilation.

https://www.ncbi.nlm.nih.gov/books/NBK557582/

Vallera, C., Choi, L. O., Cha, C. M., & Hong, R. W. (2017). Uterotonic Medications: Oxytocin,

Methylergonovine, Carboprost, Misoprostol. Anesthesiology clinics, 35(2), 207-219.

https://doi.org/10.1016/j.anclin.2017.01.007

Vogel, J. P., Chawanpaiboon, S., Moller, A. B., Watananirun, K., Bonet, M., & Lumbiganon, P.

(2018). The Global Epidemiology of Preterm Birth. Best Practice & Research Clinical

Obstetrics & Gynaecology, 52, 3-12. https://doi.org/10.1016/j.bpobgyn.2018.04.003