A case study presented to

The faculty of School of Nursing

University of Baguio

In

Partial fulfillment of the

Requirements for the subject

Presented by:

Gatuslao, Mark Noriel

Garma, Princess Ashley

Oca, Geraldine

Pataueg, Krishna Jane

October 2019
 Chapter I

Patient’s Profile

Name
Patient X

Address
41, Teodora Alonzo, Baguio City,Benguet

Age
21

Sex
Female

Occupation
N/A

Religion
Roman Catholic

Nationality
Filipino

Hospital Name
Baguio General Hospital and Medical Center

Name of
Infant Baby Girl

Time of
Delivery 7:40 AM

Date of
Delivery October 15,2019

Admitting
Diagnosis G3P3(3003) delivered cephalic term, live baby girl appropriated for
gestation age by normal
Final
Diagnosis Spontaneous delivery thinly strained amniotic fluid, one cord loop with
compression

Chapter II
 Discussion of Conception

Conception is the time when sperm travels up through the vagina, into the uterus, and
fertilizes an egg found in the fallopian tube.

Conception — and ultimately, pregnancy — can involve a surprisingly complicated series of

steps. Everything must fall into place for a pregnancy to be carried to term.

When does conception occur?

Conception occurs during the part of a woman’s menstrual cycle called ovulation. Doctors
consider day 1 of a menstrual cycle the first day of a woman’s period.

Ovulation usually occurs around the midpoint of a woman’s menstrual cycle. This would fall
around day 14 in a 28-day cycle, but it’s important to remember that even normal cycle
lengths can vary.

During ovulation, one of the ovaries releases an egg, which then travels down one of the
fallopian tubes. If there’s sperm present in a woman’s fallopian tube when this happens, the
sperm could fertilize the egg.

Usually, an egg has about 12 to 24 hours where it can be fertilized by sperm. However,
sperm can live for several days in a woman’s body.

Therefore, when the ovary releases the egg, sperm that are already present from
intercourse a few days before could fertilize it. Or, if a woman has sex during the time the
egg has been released, the sperm could fertilize the just-released egg.

Conception comes down to timing, the health of a woman’s reproductive tract, and the
quality of a man’s sperm.

Most doctors usually recommend having unprotected sex starting about three to six days
before you ovulate, as well as the day you ovulate if you wish to become pregnant. This
increases the chances that sperm will be present in the fallopian tube to fertilize the egg
once it’s released.
Conception-related concerns

Conception requires several steps to come together. First, a woman must release a healthy
egg. Some women have medical conditions that prevent them from ovulating altogether.

A woman must also release an egg healthy enough for fertilization. A woman is born with
the number of eggs she will have throughout her lifetime. As she gets older, the quality of
her eggs diminishes.

This is most true after age 35, according to the Royal College of Obstetricians and
Gynaecologists trusted Source.

High-quality sperm are also required to reach and fertilize the egg. While only one sperm is
needed, the sperm must travel past the cervix and uterus into the fallopian tubes to fertilize
the egg.

If a man’s sperm aren’t motile enough and can’t travel that far, conception can’t occur.

A woman’s cervix must also be receptive enough for the sperm to survive there. Some
conditions cause the sperm to die before they can swim to the fallopian tubes.

Some women may benefit from assisted reproductive technologies like intrauterine

insemination or in vitro fertilization if there are issues preventing healthy sperm from
meeting a healthy egg naturally.

Where does conception occur?

Sperm usually fertilizes the egg in the fallopian tube. This is a pathway from the ovary to a
woman’s uterus.
An egg takes about 30 hours to travel from the ovary down the fallopian tube.As the egg
travels down the fallopian tube, it lodges in a specific portion called the ampullar-isthmic
junction. It’s here that sperm usually fertilize the egg.

If the egg is fertilized, it will usually rapidly travel into the uterus and implant. Doctors call
the fertilized egg an embryo.

Implantation-related concerns

Unfortunately, just because an egg is fertilized, it doesn’t mean that a pregnancy will occur.

It’s possible to have damaged fallopian tubes due to a history of pelvic infections or other

disorders. As a result, the embryo could implant in the fallopian tube (improper location),
which would cause a condition called an ectopic pregnancy. This can be a medical
emergency because the pregnancy cannot continue and can cause fallopian tube rupture.

For other women, the blastocyst of fertilized cells may not implant at all, even if it reaches
the uterus.

In some cases, a woman’s uterine lining isn’t thick enough for implantation. In other cases,
the egg, sperm, or portion of the embryo may not be high quality enough to successfully
implant.

How does conception result in pregnancy?

After a sperm fertilizes an egg, cells in the embryo start to rapidly divide. After about seven
days, the embryo is a mass of multiplied cells known as a blastocyst. This blastocyst will
then ideally implant in the uterus.

As the egg travels through the fallopian tube before implantation, though, the levels of the
hormone progesterone begin rising. The increased progesterone causes the uterine lining
to thicken.

Ideally, once the fertilized egg arrives in the uterus as a blastocyst embryo, the lining will be
thick enough so it can implant.

Altogether, from the point of ovulation to implantation, this process can take about one to
two weeks. If you have a 28-day cycle, this indeed takes you to day 28 — usually the day
when you would start your period.

It’s at this point that most women can consider taking an at-home pregnancy test to see if
they’re pregnant.

At-home pregnancy tests (urine tests) work by reacting with a hormone present in your
urine known as human chorionic gonadotropin (hCG). Also known as the “pregnancy
hormone,” hCG increases as your pregnancy progresses.

Keep a few things in mind as you take an at-home pregnancy test:

First, the tests vary in their sensitivity. Some may require higher amounts of hCG to yield a
positive.

Second, women produce hCG at varying rates when they get pregnant. Sometimes a
pregnancy test can yield a positive one day after a missed period, while others can take a
week after a missed period to show a positive.

Chapter III

Anatomy and Physiology

External Female Reproductive System

1. Mons Pubis is an area of fatty tissue that covers the pubic bone in both males and
females, though it tends to be more prominent in females. It plays an
important role in secreting pheromones responsible for sexual attraction.
2. Labia Majora are a pair of rounded folds of skin and adipose that are part of the
external female genitalia. Their function is to cover and protect the inner, more
delicate and sensitive structures of the vulva, such as the labia minora, clitoris,
urinary orifice, and vaginal orifice
3. Clitoris is a small projection of erectile tissue in the vulva of the female reproductive
system. It contains thousands of nerve endings that make it an extremely sensitive
organ. Touch stimulation of the nerve endings in the clitoris produces sensations of
sexual pleasure. The clitoris is structurally and functionally homologous to the penis
of the male reproductive system, except that the clitoris does not contain the urethra
and plays no role in urination.
4. Labia Minora are a pair of thin cutaneous folds that form part of the vulva, or
external female genitalia. They function as protective structures that surround the
clitoris, urinary orifice, and vaginal orifice.
5. Vaginal opening it is located between the urethra and the anus. The opening is
where menstrual blood leaves the body. It is also used to birth a baby and for sexual
intercourse. The exterior opening to the vagina, the muscular canal that extends
from the cervix to the outside of the female body. Also called vaginal introitus
and vaginal vestibule.
6. Hymen is a thin membrane that surrounds the opening of the vagina. Hymens can
come in different shapes. The most common hymen is shaped like a half moon).
This shape allows menstrual blood to flow out of the vagina. It can serve a
protective purpose by helping to prevent things from being pushed into the vagina;
sometimes, a damaged hymen is looked at as an indicator of abuse and incest.
7. Perineum is separated from the pelvic cavity superiorly by the pelvic floor. This
region contains structures that support the urogenital and gastrointestinal systems –
and it therefore plays an important role in functions as such micturition, defecation,
sexual intercourse and childbirth.
8. Urethral opening is the external opening of the transport tube that leads from the
bladder to discharge urine outside the body in a female. The urethra in a female is
shorter than the urethra in the male. The meatus (opening) of the female urethra is
below the clitoris and just above the opening of the vagina.
Internal Female Reproductive System

1. Fundus is a part of the uterus . It is found at the top portion, opposite from the
cervix. Fundal height, measured from the top of the pubic bone, is routinely
measured in pregnancy to determine growth rates.
2. Fallopian tube is also called oviduct or uterine tube, either of a pair of long,
narrow ducts located in the human female abdominal cavity that transport
male sperm cells to the egg, provide a suitable environment for fertilization, and
transport the egg from the ovary, where it is produced, to the central channel
(lumen) of the uterus.
3. Ovary is a ductless reproductive gland in which the female reproductive cells are
produced. Females have a pair of ovaries, held by a membrane beside the uterus on
each side of the lower abdomen. The ovary is needed in reproduction since it is
responsible for producing the female reproductive cells, or ova.
4. Uterus also known as the womb, is the hollow organ in the female reproductive
system that holds a fetus during pregnancy. The uterus performs multiple functions
and plays a major role in fertility and childbearing. This organ is able to change in
shape as muscles tighten and relax to make it possible to carry a fetus.During
pregnancy, the uterus grows and the muscles become stretched and thinner, like a
balloon. Without this ability to expand, the human body would be unable to tolerate
the rapid growth of a fetus
5. Endometrium is the innermost lining layer of the uterus, and functions to prevent
adhesions between the opposed walls of the myometrium, thereby maintaining the
patency of the uterine cavity. During the menstrual cycle or estrous cycle,
the endometrium grows to a thick, blood vessel-rich, glandular tissue layer.
6. Cervix is the lower most part of the uterus and is made up of strong muscles.
The function of the cervix is to allow flow of menstrual blood from the uterus into the
vagina, and direct the sperms into the uterus during intercourse. The opening of
the cervical canal is normally very narrow.
7. Vagina is an elastic, muscular canal with a soft, flexible lining that provides
lubrication and sensation. The vagina connects the uterus to the outside world.
The vagina receives the penis during sexual intercourse and also serves as a
conduit for menstrual flow from the uterus.
Anomalies of the female genital tract

Structural anomalies of the female genital tract may be present at birth or may be acquired
later in life.

Anomalies of the uterus

Anomalies of Müllerian duct fusion

 Pathophysiology

 Defective fusion of the Müllerian ducts during embryonal development

 Normally functioning gonads and female karyotype → normal development

of secondary sexual characteristics (e.g., breast, pubic hair development)

Anomalies of Müllerian duct fusion

Types of fusion Relative Pathophysiology

anomalies frequency

Müllerian agenesis Rare Both the Müllerian ducts fail to develop → absent
or hypoplastic uterus, absent cervix, and vaginal atresia

Unicornuate uterus  10% One of the Müllerian ducts fails to develop

Didelphic 8% Complete lack of Müllerian duct fusion → double uterus,

uterus (Class III)  double cervix, double vagina

Bicornuate uterus  26% Incomplete fusion of the Müllerian ducts to various

degrees

 Uterus bicornis unicollis: double uterus,

single cervix, and single vagina

 Uterus bicornis bicollis: double uterus and

double cervix with/without a vaginal septum

Septate uterus  35% The Müllerian ducts fuse, but the septa between the two
ducts persists either partially (subseptate uterus) or
completely (septate uterus).

DES-related abnor Rare In-utero exposure to diethylstilbestrol

mality
 Vagina: adenosis, adenocarcinoma

 Cervix: cockscomb cervix, cervical collar

 Uterus: hypoplasia, uterine synechiae, T-
shaped uterine cavity

 Fallopian tube: abnormal fimbriae, cornual

budding
Intrauterine adhesions (Asherman syndrome)

Etiology

Following uterine curettage (most

common cause)

Postinflammatory (e.g., chlamydia)

 Anomalies of the vulva and vagina

Imperforate hymen

Definition: a hymen without an opening

Etiology: congenital defect

Pathophysiology: central cells of the Müllerian eminence in the urogenital sinus do not
disintegrate → imperforate hymen → cryptomenorrhea at puberty (outflow tract obstruction
leads to backup of menstrual blood) → hematocolpos

Vaginal atresia

Etiology: Müllerian agenesis

Pathophysiology

Agenesis or hypoplasia of the

Müllerian duct → atresia of the upper
⅓ of the vagina

Normally functioning gonads and

female karyotype → normal
development of secondary sexual characteristics (e.g., breast, pubic hair development)

Associated anomalies

Absent or malformed uterus and cervix (in almost all cases)

Urological malformations (25–50% of cases): single kidney, pelvic kidney, horseshoe

kidney

Skeletal malformations (10–15% of cases)

Transverse vaginal septum

Pathophysiology: Failure of recanalization of the Müllerian duct → transverse septum in the
upper-third (45%), lower third (15–20%), and/or middle third (35–40%) of the vagina

Associated with cervical hypoplasia or absence

Cryptomenorrhea → hematocolpos

Labial fusion

Definition: partial or complete adhesion of the labia minora

Etiology:

Absence of estrogen → predisposition to mild infection → local inflammation → raw surface

epithelium of the labia minora → adhesions

In rare cases: trauma (sexual abuse), congenital defect

Episiotomy

Episiotomy, also known as perineotomy, is a surgical incision of the perineum and the
posterior vaginal wall generally done by a midwife or obstetrician. Episiotomy is usually
performed during second stage of labor to quickly enlarge the opening for the baby to pass
through. The incision, which can be done at a 90 degree angle from the vulva towards the
anus or at an angle from the posterior end of the vulva (medio-lateral episiotomy), is
performed under local anesthetic (pudendal anesthesia), and is sutured after delivery.

Types of Episiotomy

a) Medio-lateral: The incision is made downward and outward from the midpoint of
the fourchette either to the right or left. It is directed diagonally in a straight line
which runs about 2.5 cm (1 in) away from the anus (midpoint between the anus and
the ischial tuberosity).

b) J-shaped: The incision begins in the centre of the fourchette and is directed
posteriorly along the midline for about 1.5 centimetres (0.59 in) and then directed
downwards and outwards along the 5 or 7 o'clock position to avoid
the internal and external anal sphincter. This procedure is also not widely practised.

c) Median: The incision commences from the centre of the fourchette and extends on
the posterior side along the midline for 2.5 cm (1 in).

d) Lateral: The incision starts from about 1 cm (0.4 in) away from the centre of the
fourchette and extends laterally. Drawbacks include the chance of injury to
the Bartholin's duct, therefore some practitioners have strongly discouraged lateral
incisions.

Placenta

It is an organ that develops in your uterus during pregnancy. This structure provides
oxygen and nutrients to your growing baby and removes waste products from your baby's
blood. The placenta attaches to the wall of your uterus, and your baby's umbilical cord
arises from it.

Placental Separation
 a) Duncan sometimes referred to as “Dirty Duncan” . It is the side attached to the
uterus, and it's so-named because it's rough-looking.

b) Schultz sometimes referred to as “Shiny Schultz.” . It is the side facing the baby, is
smooth. Typically the placenta is low in the uterus at the start of pregnancy.

3 Classic signs indicate that the placenta has separated from the uterus

1. Sudden gushing of the blood.

2. The uterus contracts and rises.
3. Lengthening of the cord.

Placenta praevia 

It is when the placenta attaches inside the uterus but near or over the cervical opening.

Symptoms include vaginal bleeding in the second half of pregnancy. The bleeding is bright
red and tends not to be associated with pain. Complications may include placenta
accreta, dangerously low blood pressure, or bleeding after delivery. Complications for the
baby may include fetal growth restriction.

Chapter IV

Stages of Labor

Early Labor Phase

The time of the onset of labor until the cervix is dilated to 3 cm.

What to do:

During this phase, you should just try to relax. It is not necessary to rush to the hospital
or birth center. Try to enjoy the comfort of the familiar surroundings at home. If early labor
occurs during the day, do some simple routines around the house.

Keep yourself occupied while conserving your energy. Drink plenty of water and eat small
snacks. Keep track of the time of your contractions. If early labor begins during the night, it
is a good idea to try to get some sleep. If you are unable to fall asleep, focus on doing
some light activities like cleaning out your closet, packing your bag, or making sack lunches
for the next day.

What to expect:

 Early labor will last approximately 8-12 hours

 Your cervix will efface and dilate to 3 cm

 Contractions will last about 30-45 seconds, giving you 5-30 minutes of rest

between contractions

 Contractions are typically mild and somewhat irregular but become progressively

stronger and more frequent

 Contractions can feel like aching in your lower back, menstrual cramps, and

pressure/tightening in the pelvic area

 Your water might break – this is known as amniotic sac rupture and can happen
anytime within the first stage of labor.

Active Labor Phase

 Continues from 3 cm. until the cervix is dilated to 7 cm.

What to do:

Now is time for you to head to the hospital or birth center. Your contractions will be
stronger, longer and closer together. It is very important that you have plenty of support.
It is also a good time to start your breathing techniques and try a few relaxation
exercises between contractions.

You should switch positions often during this time. You might want to try walking or
taking a warm bath. Continue to drink plenty of water and urinate periodically.

What to expect:

 Active labor will last about 3-5 hours

 Your cervix will dilate from 4cm to 7cm

 Contractions during this phase will last about 45-60 seconds with 3-5 minutes rest

in between

 Contractions will feel stronger and longer

 This is usually the time to head to the hospital or birth center

Transition Phase

Continues from 7 cm. until the cervix is fully dilated to 10 cm.

What to do:

During this phase, the mother will rely heavily on her support person. This is the most
challenging phase, but it is also the shortest. Try to think “one contraction at a time” (this
may be hard to do if the contractions are very close together). Remember how far you have
already come, and when you feel an urge to push, tell your health care provider.

What to expect:

 The transition will last about 30 min-2 hrs

  Your cervix will dilate from 8cm to 10cm

 Contractions during this phase will last about 60-90 seconds with a 30 second-2
minute rest in between

 Contractions are long, strong, intense, and can overlap

 This is the hardest phase but also the shortest

 You might experience hot flashes, chills, nausea, vomiting, or gas

Chapter IV

Mechanism of Labor
1.) Descent is the downward movement of the biparietal diameter of the fetal head to within
the pelvic inlet. Full descent occurs when the fetal head extrudes beyond the dilated cervix
and touches the posterior vaginal floor. Descent occurs because of pressure on the fetus
by the uterine fundus. The pressure of the fetal head on the sacral nerves at the pelvic floor
causes the mother to experience a pushing sensation. Full descent may be aided by
abdominal muscle contraction as the woman pushes.

2.) Flexion. As descent occurs and the fetal head reaches the pelvic floor, the head bends
forward onto the chest, making the smallest anteroposterior diameter (the
suboccipitobregmatic diameter) present to the birth canal. Flexion is also aided by
abdominal muscle contraction during pushing.

3.) Internal Rotation. During descent, the head enters the pelvis with the fetal
anteroposterior head diameter (suboccipitobregmatic, occipitomental, or occipitofrontal,
depending on the amount of flexion) in a diagonal or transverse position. The head flexes
as it touches the pelvic floor, and the occiput rotates to bring the head into the best
relationship to the outlet of the pelvis (the anteroposterior diameter is now in the
anteroposterior plane of the pelvis). This movement brings the shoulders, coming next, into
the optimal position to enter the inlet, putting the widest diameter of the shoulders(a
transverse one) in line with the wide transverse diameter of the inlet.

4.) External Rotation. In external rotation, almost immediately after the head of the infant
is born, the head rotates (from the anteroposterior position it assumed to enter the outlet)
back to the diagonal or transverse position of the early part of labor. This brings the
aftercoming shoulders into an anteroposterior position, which is best for entering the outlet.
The anterior shoulder is born first, assisted perhaps by downward flexion of the infant’s
head.

5.) Extension. As the occiput is born, the back of the neck stops beneath the pubic arch
and acts as a pivot for the rest of the head. The head extends, and the foremost parts of
the head, the face and chin, are born.
6.) Expulsion. Once the shoulders are born, the rest of the baby is born easily and
smoothly because of its smaller size. This movement, called expulsion, is the end of the
pelvic division of labor.

Chapter V

Assessment of Newborn Baby

APGAR Scoring

Definition: At 1 minute and 5 minutes after birth, newborns are observed and rated
according to an Apgar score, an assessment scale used as a standard since 1958. The
heart rate, respiratory effort, muscle tone, reflex irritability, and color of the infant are each
rated 0, 1, or 2; the five scores are then added. A newborn whose total score is less than 4
is in serious danger of respiratory or cardiovascular failure and needs resuscitation. A score
of 4 to 6 means that the infant’s condition is guarded and the baby may need clearing of the
airway and supplementary oxygen. A score of 7 to 10 indicates that the infant scored as
high as 70% to 90% of all infants at 1 to 5 minutes after birth or is adjusting well to
extrauterine life (10 is the highest score possible). The Apgar score is repeated every
additional 5 minutes, until a minimum score of 7 is reached. The Apgar score standardizes
infant assessment at birth and serves as a baseline for future evaluations. There is a high
correlation between low 5-minute Apgar scores and neurologic illness.

APGAR SCORING

Indicator 0 Point 1 Point 2 Points

Activity Absent Flexed arms and active

legs

Pulse Absent Below 100 bpm Over 100 bpm

Grimace Floppy Minimal response Prompt response to

to stimulation stimulation

Appearance Blue; Pale Pink body, Blue Pink

extremities

Respiration Absent Slow and irregular Vigorous cry

Anthropometric Measurements

are systematic measurements of the size, shape and composition of the human
body. Anthropometric measurements of neonates are an important clinical tool for
diagnosis of abnormally small or large neonates.

1. Head Circumference

Normal Measurement: 33 to 35 cm (13 to 14 inches) in vaginal delivery, molding may

reduce head circumference , then immediately after birth but it will return to normal size
after 2-3 days. It is actually the occipitofrontal circumference .

Abnormal Findings:

 Head Circumference less than 32 cm is indicative of microcephaly in term infants.

 Head Circumference that is 4 cm and greater than Chest Circumference or more
than 37 cm is indicative of neurologic involvement such as hydrocephalus.
2. Chest Circumference
Normal chest circumference range from 30.5 to 33(12 to 13 inches), usually 2 cm less than
head circumference .The chest circumference is measured at the level of the nipple using a
tape measure.

Abnormal Findings:

 A chest circumference less than 30cm indicates prematurity. An enlarged heart may
make the left side of the chest larger.

3. Abdominal Circumference

Is approximately the same as chest circumference . It is measured just above the level
of umbilicus . It is no longer recommended to measure abdominal circumference below
the level of umbilicus because a full bladder may interfere with accurate measurement.

4. Weight

Birth weight of full term newborn infants ranger from 6 to 8.5 lbs. or 2700 to 4000
grams. Average is 3500 grams. Birth weight should be recorded immediately after
birth because weight loss occurs rapidly in newborns. The average female infant’s
birth weight is around 7lbs. while that of male infant is around 7.5 lbs. Boys is usually
heavier than girls by 100 grams or 3 ounces. The average birth weight of Filipino
infants is 3000 grams.

Abnormal Findings:
 Birth weight less than 1000 grams for term infants is considered extremely low birth
weight.
 Birth weight less than 1500 grams in term infants is considered very low birth weight.
 Birth weight less than 2500 grams for term infants is called small for gestational age.
 Birth weight more than 4000 grams is known as large gestational age infant. Infant
may be born of a diabetic mother.
 Weight loss of more than 10% of birth weight.

Ballard Maturational Assessment

The Ballard Maturational Assessment, Ballard Score, or Ballard Scale is a commonly used

technique of gestational age assessment. It assigns a score to various criteria, the sum of
all of which is then extrapolated to the gestational age of the fetus. These criteria are
divided into physical and neurological criteria. This scoring allows for the estimation of age
in the range of 26 weeks-44 weeks. The New Ballard Score is an extension of the above to
include extremely pre-term babies i.e. up to 20 weeks.

The scoring relies on the intra-uterine changes that the fetus undergoes during its
maturation. Whereas the neurological criteria depend mainly upon muscle tone, the
physical ones rely on anatomical changes. The neonate (less than 37 weeks of age) is in a
state of physiological hypotonia. This tone increases throughout the fetal growth period,
meaning a more premature baby would have lesser muscle tone.

The neuromuscular criteria

1. Posture:muscle tone is reflected in the infant's preferred posture at rest .As maturation
progresses, the foetus gradually assumes increasing passive flexor tone at rest that
precedes in a centripetal direction with lower extremities slightly ahead of upper
extremities. term newborn (flexed posture) and preterm newborn (extended posture).

2. Square window: assessing the flexibility of the wrist. wrist flexibility and resistance to
extensor stretching are responsible for the resulting angle of flexion at the wrist.The
examiner strengthen the infant's fingers and applies gentle pressure on the dorsum of
the hand, close to the fingers .From extremely preterm to post term, the resulting angle
between the palm of the infant's hand and forearm is gradually diminished [2]

3. Arm recoil: Arm recoil examines the passive flexor tone of the biceps muscle by
measuring the angle of recoil following very brief extension of the upper extremity . With
the infant Lying supine ,the examiner places one hand beneath the infant's elbow for
support taking the infant's hand ,the examiner briefly sets the elbow in flexion, then
momentarily extents the arm before releasing it . The angle of recoil, to which the
forearm springs back into flexion is noted.

4. Popliteal angle: This maneuver assesses the maturation of passive flexor tone of the
knee extensor muscles by testing for resistance to extension of the lower extremity .
With the neonate lying supine, the thigh is placed gently on the abdomen of the knee
fully flexed. The examiner gently grasps the food at the sides with one hand while
supporting the side of the thigh with the other. Care is taken not to exert pressure on the
hamstrings. The leg is extended until a definite resistance to extension is appreciated
.At this point the angle formed at the knee by the upper and lower leg is measured.

5. Scarf sign: It is tests the passive tone of the flexors about the shoulder girdle. With
infant lying supine, the examiner adjusts the infant's head to the midline and supports
the infant's hand across the upper chest with one hand.The thumb of the examiner's
other hand is placed on the infant's elbow . The examiner tries to pull the elbow gently
across the chest , feeling for the resistance.

6. Heel To ear: This maneures measures the passive flexor tone of the posterior hip flexor
muscles.The infant is placed supine and the flexed lower extremity is brought to rest on
the cot. The examiner supports the infant's thigh laterally alongside the body with the
palm of one hand .The other hand is used to grasp the infant's foot at the sides and to
pull it towards the ipsilateral ear. Examiner feels for the resistance to extension of the
posterior pelvic girdle flexors and notes the location of the heel where significant
resistance is appreciated.

The physical criteria

These are:

1. Skin 3. Lanugo hair 5. Breast bud

2. Ear/eye 4. Plantar surface 6. Genitals

Physical Maturity of the Ballard Maturational Assessment of Gestational Age

Reco
rd
-1 0 1 2 3 4 5 Scor
e
Belo
w:
 superfic
parchm leathe
ial crackin
sticky, gelatino smooth ent, ry,
peeling g, pale
friable, us, red, pink, deep cracke
Skin &/or areas,
transpar transluc visible crackin d,
rash, rare
ent ent veins g, no wrinkl
few veins
vessels ed
veins

Abunda Thinnin Bald Mostly Spars

Lanugo None Sparse
nt g areas bald e

Heel-toe Anterior Creases

Creases
40–50 m >50 mm Faint transver over
Plantar over
m: -1 no red se anterior
surface entire
<40 mm crease marks crease 2/3 of
sole
: -2 only sole

Stippled Raised Full

Barely Flat
Imperce areola areola areola
Breast percepti areola
ptible 1–2 mm 3–4 mm 5–10 m
ble no bud
bud bud m bud

Lids Lids Sl. Well-

fused open curved curved Formed Thick
Eye and Loosely pinna pinna pinna & firm cartilag
Ear : -1 flat soft; soft but instant e
Tightly: stays slow ready recoil ear stiff
-2 folded recoil recoil

Scrotu Testes Testes Testes

Testes
Scrotu m in upper descen pendulo
Genitals down,
m flat, empty, canal, ding, us,
(Male) good
smooth faint rare few deep
rugae
rugae rugae rugae rugae

Promine
Promine Majora
Clitoris nt Majora
nt & Majora
Genitals promine clitoris cover
clitoris minora large,
(Female nt & & clitoris
& small equally minora
) labia enlargin &
labia promine small
flat g minora
minora nt
minora
 Normal Delivery Set

1. 2 Straight Kelly Forcep - A small, straight or curved hemostatic forceps used to

hold delicate tissue or compress a bleeding vessel. A small, straight or curved
forceps used in general surgery that has a locking grip with 3–5 teeth to allow rachet
clamping at various pressures

1. 1 Needle Forcep - A needle holder, also called needle driver, is a surgical instrument,
similar to a hemostat, used by doctors and surgeons to hold a suturing needle for closing
wounds during suturing and surgical procedures.
2. 1 Tissue Forcep - Tissue Forceps. Tissue forceps are used in surgical procedures for
grasping tissue. Often, the tips have "teeth" to securely hold a tissue. Typically tissue
forceps are designed to minimize damage to biological tissue.

3. 1 Placenta Bowl - Placenta bowls, or 'ipu whenua', carried the placenta delivered from the
mother's body after she had given birth. The placenta organ supplies the fetus with oxygen
and nutrients while in the womb. It develops alongside the child and is expelled from the
body after the child is born.

Dilation and curettage (D&C Set)

1. 1 Hysterometer - The Hysterometer is a device for sounding of the uterus and comes
in different variants. The Polyethylene cursor is designed for accurate and easy
reading of the uterine dept

2. 1 Allis Forceps - An Allis clamp is a commonly used surgical instrument. The allis
clamp is surgical instrument with sharp teeth, used to hold or grasp heavy tissue. It is
also used to grasp fascia and soft tissues such as breast or bowel tissue. Allis clamps
can cause damage, so they are often used in tissue about to be removed.
1 Ovum Forceps - Ovum forceps are commonly used to remove placental fragments
inside the uterus. It is also used as a hemostat or a clamping instrument. ... All of our
ovum forceps are made from high quality German stainless steel and carry a lifetime
guarantee.

3. 1 Curette - A surgical instrument used to remove material by a scraping action,

especially from the uterus.

4. 1 Uterine Forceps - Double-curved for optimal uterine insertion, the Bozeman Uterine
Forceps are a universal tool for various situations, such as holding gauze and
sponges, manipulating tissue as well as doubling up as a longer hemostat

5. 1 Pair Vaginal Speculum - Speculum, vaginal: An instrument used to widen the

opening of the vagina so that the cervix is more easily visible. "Speculum" is the Latin
word for mirror