normal spontaneous delivery
TRANSCRIPT
![Page 1: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/1.jpg)
NORMAL SPONTANEOUS DELIVERY
![Page 2: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/2.jpg)
2
Involves the birth of a babyand delivery of the placentafrom the uterus and throughthe cervix and the birth canal
![Page 3: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/3.jpg)
3
MANIFESTATIONS
FatigueBreast swelling Nausea and vomiting Smell is more sensitive Amenorrhea Tenderness of the breast
![Page 4: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/4.jpg)
4
COMPLICATIONS Back pain particularly in the third
trimester Constipation due to decrease motility
secondary to elevated progesterone Dehydration caused by expanded
intravascular space and increased third spacing of fluids
Edema caused by compression of the inferior vena cava and pelvic veins by the uterus leads to increased hydrostatic pressure in lower extremities
Varicose Veins due to relaxation of the venous smooth muscle and increased intravascular pressure
![Page 5: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/5.jpg)
5
PHYSIOLOGIC CHANGESDURING PREGNANCY
![Page 6: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/6.jpg)
6
INTEGUMENTARYSYSTEM
![Page 7: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/7.jpg)
7
Striae Gravidarum
![Page 8: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/8.jpg)
8
Umbilicus protrudes as a round bump at the center of the abdominal wall
![Page 9: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/9.jpg)
9
Linea Nigra
![Page 10: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/10.jpg)
10
Melasma/ Mask of Pregnancy
![Page 11: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/11.jpg)
11
Telangiectases
![Page 12: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/12.jpg)
12
Palmar Erythema
![Page 13: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/13.jpg)
13
↑ Perspiration
![Page 14: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/14.jpg)
14
RESPIRATORYSYSTEM
![Page 15: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/15.jpg)
15
Acute sensation of shortness of breath
Vital capacity does not ↓↓ Residual volume up to 20%↑ tidal volume up to 40%↑ Total oxygen consumption by as
much as 20%Total ventilation capacity may
have risen by as much as 40% at full term
Slight ↑ in pH in serum↑ RR
![Page 16: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/16.jpg)
16
TEMPERATURE
Slightly ↑
![Page 17: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/17.jpg)
17
CARDIOVASCULARSYSTEM
![Page 18: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/18.jpg)
18
↑ Blood volume (30% to 50% or 1500mL to 3 units)
Total blood volume during pregnancy is about 5 liters
BLOOD VOLUME
![Page 19: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/19.jpg)
19
IRON, FOLIC ACID AND VITAMIN NEEDS
↑ Total need of Iron is about 800mg
↑ need for Folic Acid
![Page 20: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/20.jpg)
20
HEART
↑ cardiac output about 30%↑ HR by 10 beats per
minute
![Page 21: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/21.jpg)
21
PERIPHERAL BLOOD FLOW
During the third trimester, blood flow to the lower extremities is impaired by the pressure of the expanding uterus on veins and arteries which can lead to edema and varicosities
![Page 22: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/22.jpg)
22
SUPINE HYPOTENSION SYNDROME
↓ in blood return to the heart Can cause fetal hypoxia
![Page 23: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/23.jpg)
23
BLOOD CONSTITUTION
↑ fibrinogen about 50% Slightly ↑ Total WBC count↓ Total protein level↑ blood lipids by 1/3 ↑ cholesterol serum level by
90% to 100%
![Page 24: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/24.jpg)
24
GASTROINTESTINALSYSTEM
![Page 25: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/25.jpg)
25
Morning sickness, nausea and vomiting
Heartburn Slow intestinal peristalsis
and emptying time of the stomach
↓ gastric motility ↑ saliva formation
![Page 26: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/26.jpg)
26
URINARY SYSTEM
![Page 27: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/27.jpg)
27
FLUID RETENTION
Water is retained to aid ↑ in blood volume and to serve as a ready source of fluid for the fetus
↑ response of angiotensin renin system in the kidney
![Page 28: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/28.jpg)
28
RENAL FUNCTION
↑ urinary output (60%-80%)↓ specific gravity ↑ GFR and renal plasma flow↓ BUN Normal creatinine is to 90 to
180 mL/min to assess renal function
![Page 29: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/29.jpg)
29
URETER AND BLADDER FUNCTION
Frequent urination
↑ diameter of the ureter and bladder capacity ↑ to about 1500 mL
![Page 30: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/30.jpg)
30
SKELETAL SYSTEM
![Page 31: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/31.jpg)
31
↑ need in calcium and phosphorus Gradual softening of a woman’s
pelvic ligament and jointsWide separation of the symphisis
pubis as much as 3 to 4 mm by 32 weeks of pregnancy
![Page 32: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/32.jpg)
32
ENDOCRINE SYSTEM
![Page 33: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/33.jpg)
33
Placenta produces large amounts of estrogen, progesterone and relaxin, hCG, hPL
FSH and LH ↓ ↑ production of growth hormone and
melanocyte-stimulating hormoneOxytocin and prolactin production in
late in pregnancy ↑ thyroid and parathyroid hormone
production ↑ adrenal activity ↑ level of aldosterone ↑ production of insulin
![Page 34: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/34.jpg)
34
IMMUNE SYSTEM
↓ immunologic competency ↓igG production
![Page 35: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/35.jpg)
35
PHYSIOLOGIC CHANGESDURING LABOR
![Page 36: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/36.jpg)
36
CARDIOVASCULARSYSTEM With the ↑ cardiac output
caused by contractions during labor results in an ↑ systolic and diastolic blood pressure
![Page 37: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/37.jpg)
37
During labor, development of leukocytosis occur, or a sharp ↑ in the number of circulating WBC. At the end of labor, the average woman has a WBC count of 25,000 to 30,000 cells mm3
HEMOPOIETIC SYSTEM
![Page 38: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/38.jpg)
38
RESPIRATORY SYSTEM
↑RR to supply additional oxygen. Total oxygen consumption ↑by about 100% during the second stage of labor
![Page 39: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/39.jpg)
39
TEMPERATURE REGULATION
↑ muscular activity associated with labor can result in a slight ↑ elevation in temperature
![Page 40: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/40.jpg)
40
FLUID BALANCE
↑ sensible water loss during labor because of the ↑in rate and depth of respirations which causes moisture to be lost with each breath
![Page 41: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/41.jpg)
41
URINARY SYSTEM Kidneys begin to
concentrate urine to preserve both fluid and electrolytes. Specific gravity may ↑↓ bladder tone
![Page 42: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/42.jpg)
42
GASTROINTESTINAL SYSTEM
Inactive during labor probably because of shunting of blood to more life sustaining organs and also because of pressure on the stomach and intestines from the contracting uterus
client may experience a loose bowel movement as contractions grow strong
![Page 43: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/43.jpg)
43
NEUROLOGIC ANS SENSORY RESPONSES
Neurologic responses that occur during labor are responses r/t pain. This pain is registered at uterine and cervical nerve pelxuses. At the moment of birth, the pain is centered on the perinuem as it stretches to allow the fetus to move past it. Perineal pain is registered at S2 to S4 nerves
![Page 44: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/44.jpg)
44
GENERAL DATANAME: B.B.NAGE: 44 years oldADDRESS: Sampaloc Site 2, BF ParañaqueRELIGION: CatholicSTATUS: MarriedNATIONALITY: FilipinoOCCUPATION: Unemployed (Housewife)DATE OF BIRTH: July 13, 1967BIRTH PLACE: Bonga, Banay CapizDIALECT: Filipino, EnglishEDUCATIONAL ATTAINMENT: Highschool
Graduate
![Page 45: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/45.jpg)
45
DATE OF ADMISSION: September 3, 2011ADMITTING DIAGNOSIS: Pregnancy
Uterine 40-42 weeks Age of Gestation Cephalic in Labor, Premature Rupture of Membrane G6P5(5005)
FINAL DIAGNOSIS: Pregnancy Uterine Normal Spontaneous Delivery, Cephalic G6P6(6006)
INITIAL VITAL SIGNS:• BP: 120/80 mmHg • PR: 80 bpm • RR: 20 cpm • TEMPERATURE: 36.5 ˚C
![Page 46: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/46.jpg)
46
GENERAL DATA FOR OBCHIEF COMPLAINT: Lumbosacral PainLAST MENSTRUAL PERIOD:November 27, 2010AGE OF GESTATION: 40-41 weeksPRENATAL CARE: NoPRENATAL ILLNESS: NegativeOTHER PERTINENT ILLNESS:
(-) HPN (-) Asthma (-) DM(-) Allergy (-) Heart Disease
VITAL SIGNS:BP: 120/70 mmHg FUNDIC HEIGHT: 30 cm
PR: 76 bpm FETAL HEART TONE: 135 @ RLQ
RR: 20 cpm WEIGHT: 42 kgs
TEMPERATURE: 36.5 ˚C
![Page 47: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/47.jpg)
47
FEMALE REPRODUCTIVE SYSTEM
![Page 48: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/48.jpg)
48
EXTERNAL STRUCTURES• MONS VENERIS – pad of adipose tissue located over the symphisis pubis. It protect the junction of the pubic bone from trauma
![Page 49: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/49.jpg)
49
• LABIA MINORA – two hairless folds of connective tissue just posterior the mons veneris. Normally the folds are pink, internal surface is covered with mucous membrane and the external with skin
![Page 50: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/50.jpg)
50
• LABIA MAJORA – two folds of adipose tissue that are positioned lateral to the labia minora. It covers the genitalia and the distal urethra and vagina
![Page 51: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/51.jpg)
51
• CLITORIS – is small rounded organ of erectile tissue at the forward junction of the labia minora. It is the center of orgasm in a woman.
![Page 52: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/52.jpg)
52
• SKENE’S GLAND – or paraurethral glands; located just lateral to the urinary meatus, one on each side. Their ducts open into the urethra
![Page 53: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/53.jpg)
53
• BARTHOLIN’S GLANDS – located just lateral to the vaginal opening on both sides. Their ducts open into the distal opening. Secretions from these both glands help to lubricate the external genitalia during coitus
![Page 54: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/54.jpg)
54
• FOURCHETTE – ridge tissue formed by the posterior joining of the two labia majora. This is the structure that is sometimes cut during childbirth to enlarge the vaginal opening
![Page 55: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/55.jpg)
55
•HYMEN – tough but elastic semicircle of tissue that covers the opening to the vagina in childhood
![Page 56: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/56.jpg)
56
INTERNAL STRUCTURES• OVARIES – approx. 4cm long by 3cm in diameter and approx. 1.5cm thick . It produce mature and discharge ova and produce estrogen and progesterone and initiate and regulate menstrual cycle
![Page 57: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/57.jpg)
57
• FALLOPIAN TUBES – arise from each upper corner of the uterine body. Approximately 10cm long. Their function is to convey the ovum from the ovaries to the uterus and to provide a place for fertilization of the ovum
![Page 58: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/58.jpg)
58
• FOUR SEPARATE PARTS OF FALLOPIAN TUBES:1. INTERSTITIAL – lies within the uterine wall. Only about 1cm in length. The lumen of the tube is only 1mm in diameter at this point
![Page 59: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/59.jpg)
59
2. ISTHMUS – approx. 2cm in length and extremely narrow. It is cut or sealed in a tubal ligation, or tubal sterilization procedure
![Page 60: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/60.jpg)
60
3. AMPULLA – longest portion of the tube. Approximately 5cm in length. It is in this portion that fertilization of an ovum usually occurs
![Page 61: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/61.jpg)
61
4. INFUNDIBULAR – approximately 2cm long and is funnel shaped. The rim of the funnel is covered by fimbria that help to guide the ovum into the fallopian tube
![Page 62: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/62.jpg)
62
• UTERUS – hollow, muscular, pear-shaped organ located in the lower pelvis, posterior to the bladder and anterior to the rectum.
• 3 DIVISIONS:1. Body2. Isthmus3. Cervix
![Page 63: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/63.jpg)
63
• CERVICAL CANAL – central cavity• INTERNAL CERVICAL OS – opening of the canal at the junction of the cervix and isthmus• EXTERNAL CERVICAL OS – distal opening to the vagina. The level is at the level of ischial spine.
![Page 64: Normal Spontaneous Delivery](https://reader033.vdocuments.mx/reader033/viewer/2022050919/547beb74b4af9f52558b4583/html5/thumbnails/64.jpg)
64
ULTRASOUND
• JUNE 27, 2011IMPRESSION:
Single, live, intrauterine pregnancy of about 30 weeks 2 days Age of GestationNormal placental localization
Cephalic presentation.