A case scenerio has been presented on Normal Labour !

1. Dr. Sara Khalid Memon
Group B4
Final Year, MBBS
CLINICAL CASES OF
NORMAL LABOUR

2. 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 30/3/15
Gestational age: 38 weeks
Married since: 4 years
MOD of Last baby: NVD
1st, 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 months
No Pap smear done and contraception never taken !
Patient is Vitally stable !
 CASE SCENARIO # 01

3. 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

4. On P/V
Vulva and Vagina: Normal
Cervical dilation: 1cm
Effacement: 20%
Presenting part (station): -3
Pelvis: Adequate

5. Your diagnosis ???
TRUE Labour
OR FALSE ???

7. NEXT TO DO, IS ???
Whether to admit OR not ??
Partogram should be maintained at
this time OR not ?

8. Patient comes with moderate pains after 6 hrs with increase in frequency of pains
On doing P/A examination
SFH: 36 cm
LIE: Longitudinal
PRESENTATION: Cephalic
No. of FIFTHS PALPABLE: 4/5
CONTRACTIONS: 2/10mins(with each contraction lasting for <20 seconds)
FHR: 140 beats/min
On doing P/V examination
Cervical dilatation : 4cm
Membranes : Intact
Station: -2
Effacement: 60%
NEXT VISIT/EXAMINATION

9. PARTOGRAPH
“An essential
tool for
monitoring
Labour”

10. PASSENGER PARAMETERS
PASSAGE PARAMETERS
POWER PARAMETERS

11. 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

12. • 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

13. PASSENGER PARAMETERS
PASSAGE PARAMETERS
POWER PARAMETERS

14. Reassess the patient
Empty bladder
Hydrate her
Encourage upright
position
Encourage walking
Monitor intensively
YELLOW ZONE ??
SYNTOCINON

15. PASSENGER
PARAMETER
PASSAGE PARAMETER
POWER PARAMETER
SYNTOCINON
Delivered a baby at
2:15pm ! Alive baby
girl, healthy, with
apgar score of 10