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A Case Study on Normal Spontaneous Vaginal Delivery

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In partial fulfillment

Of the requirements

For the subject N201-RLE

Submitted By:

Submitted To:



Purpose and Objectives of the Study 9

Significance and Justification of the Study 10

Scope and Limitations 10

Background of the Study 11








Pregnancy is defined as the state of carrying a developing embryo or fetus within the female body. When the growth and development of the fetus is completed, it undergoes the process of delivery. Delivery has two options, Cesarean, or normal delivery. A Caesarean section, is a surgical incision through a mother's abdomen and uterus to deliver one or more fetuses.

Normal delivery is the delivery of the baby through the vaginal route. It can be called normal spontaneous delivery (NSD) or spontaneous vaginal delivery (SVD). The connotation of this is that the baby was delivered through the efforts of the mother.

Normal labor is defined as the gradual effacement and dilatation of the uterine cervix as a result of rhythmic uterine contractions leading to the expulsion of the products of conception (i.e., delivery of the fetus, membranes, umbilical cord, and placenta). Obstetricians have divided labor into 4 stages, thereby delineating milestones in a process that is obviously continuous. Stage 1: The first stage begins with regular uterine contractions and ends with complete cervical dilatation at 10 cm. Stage 1 has been further subdivided into an earlier latent phase (0-3 cm dilation) and an ensuing active phase, which begins at about 4-7 cm of cervical dilatation and heralds a period of more rapid cervical dilation, the transition phase is from 8-10 cm. Stage 2: Once the cervix has completely dilated, the second stage of labor has begun. Stage 2 ends with delivery of the fetus. Stage 3: The third stage of labor lasts from the delivery of the fetus until the delivery of the placenta. Stage 4 is from the placental delivery to full recovery of the mother.

Vaginal delivery is not always spontaneous. Sometimes it is necessary to use forceps in cases where the efforts of the mother are not enough to expel the baby. Forceps delivery is more risky but when indicated, it can save the child from further damage or even possible death. Minor effects like a mark on the baby's face or head due to the forceps are usually transient and will disappear after some time.

Another form of vaginal delivery is breech extraction. This is done in cases where the baby's buttocks are the presenting part, provided the baby meets certain criteria for a safe breech extraction.

Labor and delivery of the fetus entails physiological effects both on the mother and the fetus. In the cardiovascular system, The mother’s cardiac output increases because of the increase in the needed amount of blood in the uterine area. Blood pressure may also rise due to the effort exerted by the mother in order expel the fetus. There could also be a development of leukocytes or a sharp increase in the number of circulating white blood cells possibly as a result of stress and heavy exertion. Increased respiratory may also occur. This happens as a response to the increase in blood supply in order to increase also the oxygen intake.

Braxton Hicks contractions (false contractions) must be differentiated from true contractions. The former are usually less intense, and they are focused over the lower abdomen and groin areas. They often resolve with ambulation. True labor, however, lasts longer and is more intense. True labor is felt in the upper and mid abdomen and leads to the cervical changes that define true labor.

Patients may also describe what has been called lightening, i.e., physical changes felt because of the fetal head advancing into the pelvis. The mother may feel that her baby has become lighter or started to drop, and the abdominal shape may change to reflect the descent of the fetus. Breathing may be relieved from less tension on the diaphragm, while urination may become more frequent because of added pressure on the bladder.

The assessment of the pregnant mother is also important to note. The abdominal examination begins with the Leopold maneuvers. The initial maneuver involves the examiner placing both hands in each upper quadrant of the patient's abdomen. This allows the examiner to determine what lies in the uterine fundus, ie, fetal head versus lower limbs (breech). The second maneuver involves palpation with both hands in the paraumbilical regions, differentiating the fetal spine from limbs, thus allowing determination of fetal position. The third maneuver is suprapubic palpation with a single dominant hand. As with the first maneuver, this allows the examiner to ascertain fetal presentation and to estimate fetal station. The final maneuver involves palpation of bilateral lower quadrants with the aim of delineating the fetal head, further determining station.

The pelvic examination is performed in a sterile fashion to decrease the risk of infection. Sterile gloves are preferred. If membrane rupture is suspected, a sterile speculum examination is performed to provide confirmation. Digital examination of the vagina allows determination of cervical position (anterior or posterior), effacement (reported as a percentage of the normal 3- to 4-cm length), consistency (soft or firm), and dilatation (ranging from zero, or “finger tip,” to fully dilated



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