Delivery Room write up
Content
Delivery Room Write Up
Benguet General Hospital Delivery and Labor Room June 17-June 26, 2013
Submitted by: Calalo, Kevin Ryan D. BSN IV
I.
Introduction
Pregnancy is the state of carrying a developing embryo or fetus within the female body. This condition can be indicated by positive results on an over-the-counter urine test, and confirmed through a blood test, ultrasound, detection of fetal heartbeat, or an X-ray.
Pregnancy lasts for nine months, measured from the date from the woman’s last menstrual period. It is conventionally divided into three trimesters, each roughly three months long.
When gestation has completed, it goes through a p r o c e s s called delivery, where the developed fetus is expelled from the mother’s womb. There are two options of delivery: Cesarean section and NSVD or normal spontaneous vaginal delivery. A cesarean section is a surgical incision through the mother’s abdomen and uterus to deliver one or more fetuses. NSVD or normal spontaneous vaginal delivery is the delivery of t h e b a b y t h r o u g h v a g i n a l r o u t e . I t c a n a l s o b e c a l l e d N S D o r n o r m a l spontaneous delivery, or SVD or spontaneous vaginal delivery, where the mother delivers the baby with effort and force exertion. Normal labor is defined as the gradual subjugat i o n a n d dilatation of the uterine cervix as a result of rhythmic uterine contractions leading to the expulsion of the products of conception: the delivery of the fetus, membranes,
umbilical cord, and placenta. Laboring cannot that be easy; thereby implicating that there are processes an d s t a g e s t o b e undertaken to achieve spontaneous delivery.
II.
Patient’s Profile
Patient Name: Patient X Address: 95 Banig, Tawang Age: 21 Gravida: 3 Para: 2 Date of Delivery: June 18, 2013 Time: 2:35 AM Type: Normal Spontaneous Delivery Admitting Diagnosis: G2P1 Pregnancy uterine 38 5/7 AOG CIL Final Diagnosis: G3P2 Pregnancy uterine 38 5/7 AOG CIL
III. Anatomy and Physiology
EXTERNAL GENITALIA Our overview of the reproductive system begins at the external genital area— or vulva— which runs from the pubic area downward to the rectum. Two folds of fatty, fleshy tissue surround the entrance to the vagina and the urinary opening: the a). Labia majora- outer folds b). Labia minora- inner folds, located under the labia majora
c). Clitoris- is a relatively short organ (less than one inch long), shielded by a hood of flesh. When stimulated sexually, the clitoris can become erect like a man's p e n i s . d). Hymen- a t h i n m e m b r a n e p r o t e c t i n g t h e e n t r a n c e o f t h e vagina, stretches when you insert a tampon or have intercourse
INTERNAL REPRODUCTIVE STRUCTURE
a). Vagina - The vagina is a muscular, ridged sheath connecting the external genitals to the uterus, where
t h e e m b r y o g r o w s i n t o a f e t u s d u r i n g pregnancy. In the reproductive process, the vagina functions as a two-way street, accepting the penis and sperm during intercourse and roughly
nine months later, serving as the avenue of birth through which the new baby enters the world. b). Cervix- T h e v a g i n a e n d s a t t h e c e r v i x , t h e l o w e r
p o r t i o n o r n e c k o f t h e uterus. Like the vagina, the cervix has dual reproductive functions. After intercourse, sperm ejaculated in the vagina pass through the cervix, then proceed through the uterus to the fallopian tubes where, if a sperm encounters an ovum (egg), conception occurs. The cervix is lined with mucus, the quality and quantity of which is governed by monthly fluctuations in the
levels of the two principle sex hormones, estrogen and progesterone. c ) . U t e r u s - The uterus or womb is the major female reproductive organ of humans. One end, the cervix, opens into the vagina; the other is connected on both sides to the fallopian tubes. The uterus mostly consists of muscle, known as myometrium. Its major function is to accept a fertilized ovum which becomes implanted into the endometrium, and derives nourishment from blood vessels which develop exclusively for this purpose. The fertilized ovum becomes an embryo, develops into a fetus and gestates until childbirth. d). Oviducts- the Fallopian tubes or oviducts are two very fine tubes
leading from the ovaries of female mammals into the uterus. On maturity of an ovum, the follicle and the ovary's wall rupture, allowing the ovum to escape and enter the Fallopian tube. There
it travels toward the uterus, pushed along by movements of cilia on the inner lining of the tubes. This trip takes hours or days. If the ovum is fertilized while in the Fallopian tube, then it normally implants in the endometrium when it reaches the uterus, which signals the beginning of pregnancy. e). Ovaries - The ovaries are the place inside the female
body whereovaoreggs a r e p r o d u c e d . T h e p r o c e s s b y w h i c h t h e o v u m i s r e l e a s e d i s c a l l e d ovulation. The speed of ovulation is periodic and impacts directly to the length of a menstrual cycle. After ovulation, the ovum is captured by the oviduct cycle, wh e r e i t travelled down the oviduct to the uterus,
occasionally being fertilize and don i t s w a y b y a n i n c o m i n g sperm, leading to pregnancy and the eventual birth of a new human being. The Fallopian tubes are often called the oviducts and they have small hairs (cilia) to help the egg cell travel.
IV.
PATHOPHYSIOLOGY
Stages of labor 1. 1st stage
Phase I: latent, dilation= 0-3, duration/interval=20-40 sec. /5-30 minutes, mild to moderate Phase II: active, dilation=4-7 cm, duration/interval=40-60 sec. /3-5 minutes, moderate to strong Phase III: transition, dilation=8-10cm, duration=60-90 sec. /23minutes, strong 2. 2nd stage
Phase I: station= 0 to + 2, contraction=2-3 minutes apart Phase II: station= + to +4, contraction= 2 to 2.5 mins. Apart with urgency to bear down Phase III: station= +4 to birth, contraction= to 2 mins. Apart; fetal head visible increased.
Mechanisms of labor/cardinal movements 1.Engagement Fetal presenting part (normally the head) as its widest diameter reaches the level of the ischial spines of the pelvis 2.Descent Downward movement of the biparietal diameter of the fetal head until it reaches the pelvic inlet Pressure of the fetal head on the sacral nerve produces a pushing sensation which is experienced by the mother in labor 3.Flexion Shortest head diameter pass through the pelvis Fetal head reaches the pelvic floor; head bends forward onto chest, presenting the smallest anteropo
sterior
diameter
4. Internal rotation Allows the longest fetal head diameters to match the longest maternal pelvic diameter and fetus enters the pelvic inlet
5. Extension Internal rotation is complete Fetal head passes beneath the symphysis pubis while inflexion; there is a resistance from tissues of the pelvic floor in the fetal head. Fetal neck stops and act as a pivot. This combination causes the fetal head t o m o v e anteriorly, or extend, while mother is pushing. 6. External rotation Allow the shoulders fit 7. t h e pelvis to rotate internally to
Expulsion
Expulsion occurs first as the anterior, ten posterior shoulder passes under the symphysis pubis
After the shoulder delivery, rest of the body will follow
3. 3rd stage
Placental delivery = 2 phases (placental separation and placental expulsion)
•Sudden gush of blood •Lengthening of the cord •rising of the fundus •globular uterus 4). 4th stage: First four hours after delivery of the placenta
B). Schematic Diagram
V.
Instrumentation
Mayo Curve
Used to cut the ligatures or other suture material during operation by the assistant surgeon or scrub nurse, it is also used to cut the tissues and internal organs so that adjacent tissues are protected while using it. Canal so used to do the episiotomy in second stage of labor without causing damage to the surrounding tissues in the perineum.
Mayo Straight Used for cutting the ligatures and sutures. It is also used for removing sutures of incision
Metzenbaum
Used to cut delicate tissues
Needle Holder Holds needle in place for the procedure
Tissue Forceps Helps pick up tissue
Benguet General Hospital Delivery and Labor Room June 17-June 26, 2013
Submitted by: Calalo, Kevin Ryan D. BSN IV
I.
Introduction
Pregnancy is the state of carrying a developing embryo or fetus within the female body. This condition can be indicated by positive results on an over-the-counter urine test, and confirmed through a blood test, ultrasound, detection of fetal heartbeat, or an X-ray.
Pregnancy lasts for nine months, measured from the date from the woman’s last menstrual period. It is conventionally divided into three trimesters, each roughly three months long.
When gestation has completed, it goes through a p r o c e s s called delivery, where the developed fetus is expelled from the mother’s womb. There are two options of delivery: Cesarean section and NSVD or normal spontaneous vaginal delivery. A cesarean section is a surgical incision through the mother’s abdomen and uterus to deliver one or more fetuses. NSVD or normal spontaneous vaginal delivery is the delivery of t h e b a b y t h r o u g h v a g i n a l r o u t e . I t c a n a l s o b e c a l l e d N S D o r n o r m a l spontaneous delivery, or SVD or spontaneous vaginal delivery, where the mother delivers the baby with effort and force exertion. Normal labor is defined as the gradual subjugat i o n a n d dilatation of the uterine cervix as a result of rhythmic uterine contractions leading to the expulsion of the products of conception: the delivery of the fetus, membranes,
umbilical cord, and placenta. Laboring cannot that be easy; thereby implicating that there are processes an d s t a g e s t o b e undertaken to achieve spontaneous delivery.
II.
Patient’s Profile
Patient Name: Patient X Address: 95 Banig, Tawang Age: 21 Gravida: 3 Para: 2 Date of Delivery: June 18, 2013 Time: 2:35 AM Type: Normal Spontaneous Delivery Admitting Diagnosis: G2P1 Pregnancy uterine 38 5/7 AOG CIL Final Diagnosis: G3P2 Pregnancy uterine 38 5/7 AOG CIL
III. Anatomy and Physiology
EXTERNAL GENITALIA Our overview of the reproductive system begins at the external genital area— or vulva— which runs from the pubic area downward to the rectum. Two folds of fatty, fleshy tissue surround the entrance to the vagina and the urinary opening: the a). Labia majora- outer folds b). Labia minora- inner folds, located under the labia majora
c). Clitoris- is a relatively short organ (less than one inch long), shielded by a hood of flesh. When stimulated sexually, the clitoris can become erect like a man's p e n i s . d). Hymen- a t h i n m e m b r a n e p r o t e c t i n g t h e e n t r a n c e o f t h e vagina, stretches when you insert a tampon or have intercourse
INTERNAL REPRODUCTIVE STRUCTURE
a). Vagina - The vagina is a muscular, ridged sheath connecting the external genitals to the uterus, where
t h e e m b r y o g r o w s i n t o a f e t u s d u r i n g pregnancy. In the reproductive process, the vagina functions as a two-way street, accepting the penis and sperm during intercourse and roughly
nine months later, serving as the avenue of birth through which the new baby enters the world. b). Cervix- T h e v a g i n a e n d s a t t h e c e r v i x , t h e l o w e r
p o r t i o n o r n e c k o f t h e uterus. Like the vagina, the cervix has dual reproductive functions. After intercourse, sperm ejaculated in the vagina pass through the cervix, then proceed through the uterus to the fallopian tubes where, if a sperm encounters an ovum (egg), conception occurs. The cervix is lined with mucus, the quality and quantity of which is governed by monthly fluctuations in the
levels of the two principle sex hormones, estrogen and progesterone. c ) . U t e r u s - The uterus or womb is the major female reproductive organ of humans. One end, the cervix, opens into the vagina; the other is connected on both sides to the fallopian tubes. The uterus mostly consists of muscle, known as myometrium. Its major function is to accept a fertilized ovum which becomes implanted into the endometrium, and derives nourishment from blood vessels which develop exclusively for this purpose. The fertilized ovum becomes an embryo, develops into a fetus and gestates until childbirth. d). Oviducts- the Fallopian tubes or oviducts are two very fine tubes
leading from the ovaries of female mammals into the uterus. On maturity of an ovum, the follicle and the ovary's wall rupture, allowing the ovum to escape and enter the Fallopian tube. There
it travels toward the uterus, pushed along by movements of cilia on the inner lining of the tubes. This trip takes hours or days. If the ovum is fertilized while in the Fallopian tube, then it normally implants in the endometrium when it reaches the uterus, which signals the beginning of pregnancy. e). Ovaries - The ovaries are the place inside the female
body whereovaoreggs a r e p r o d u c e d . T h e p r o c e s s b y w h i c h t h e o v u m i s r e l e a s e d i s c a l l e d ovulation. The speed of ovulation is periodic and impacts directly to the length of a menstrual cycle. After ovulation, the ovum is captured by the oviduct cycle, wh e r e i t travelled down the oviduct to the uterus,
occasionally being fertilize and don i t s w a y b y a n i n c o m i n g sperm, leading to pregnancy and the eventual birth of a new human being. The Fallopian tubes are often called the oviducts and they have small hairs (cilia) to help the egg cell travel.
IV.
PATHOPHYSIOLOGY
Stages of labor 1. 1st stage
Phase I: latent, dilation= 0-3, duration/interval=20-40 sec. /5-30 minutes, mild to moderate Phase II: active, dilation=4-7 cm, duration/interval=40-60 sec. /3-5 minutes, moderate to strong Phase III: transition, dilation=8-10cm, duration=60-90 sec. /23minutes, strong 2. 2nd stage
Phase I: station= 0 to + 2, contraction=2-3 minutes apart Phase II: station= + to +4, contraction= 2 to 2.5 mins. Apart with urgency to bear down Phase III: station= +4 to birth, contraction= to 2 mins. Apart; fetal head visible increased.
Mechanisms of labor/cardinal movements 1.Engagement Fetal presenting part (normally the head) as its widest diameter reaches the level of the ischial spines of the pelvis 2.Descent Downward movement of the biparietal diameter of the fetal head until it reaches the pelvic inlet Pressure of the fetal head on the sacral nerve produces a pushing sensation which is experienced by the mother in labor 3.Flexion Shortest head diameter pass through the pelvis Fetal head reaches the pelvic floor; head bends forward onto chest, presenting the smallest anteropo
sterior
diameter
4. Internal rotation Allows the longest fetal head diameters to match the longest maternal pelvic diameter and fetus enters the pelvic inlet
5. Extension Internal rotation is complete Fetal head passes beneath the symphysis pubis while inflexion; there is a resistance from tissues of the pelvic floor in the fetal head. Fetal neck stops and act as a pivot. This combination causes the fetal head t o m o v e anteriorly, or extend, while mother is pushing. 6. External rotation Allow the shoulders fit 7. t h e pelvis to rotate internally to
Expulsion
Expulsion occurs first as the anterior, ten posterior shoulder passes under the symphysis pubis
After the shoulder delivery, rest of the body will follow
3. 3rd stage
Placental delivery = 2 phases (placental separation and placental expulsion)
•Sudden gush of blood •Lengthening of the cord •rising of the fundus •globular uterus 4). 4th stage: First four hours after delivery of the placenta
B). Schematic Diagram
V.
Instrumentation
Mayo Curve
Used to cut the ligatures or other suture material during operation by the assistant surgeon or scrub nurse, it is also used to cut the tissues and internal organs so that adjacent tissues are protected while using it. Canal so used to do the episiotomy in second stage of labor without causing damage to the surrounding tissues in the perineum.
Mayo Straight Used for cutting the ligatures and sutures. It is also used for removing sutures of incision
Metzenbaum
Used to cut delicate tissues
Needle Holder Holds needle in place for the procedure
Tissue Forceps Helps pick up tissue
