Clinical cases of normal labour - By Sara Khalid Memon

Dr. Sara Khalid MemonGroup B4

Final Year, MBBS

CLINICAL CASES OF NORMAL LABOUR

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

Your diagnosis ???

TRUE Labour

OR FALSE ???

NEXT TO DO, IS ???

Whether to admit OR not ??

Partogram should be maintained at

this time OR not ?

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

PARTOGRAPH

“An essential

tool for

monitoring

Labour”

PASSENGER PARAMETERS

PASSAGE PARAMETERS

POWER PARAMETERS

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

PASSENGER PARAMETERS

PASSAGE PARAMETERS

POWER PARAMETERS

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