LABOR AND DELIVERY

CASE SCENARIO 3: Belle

Belle came in to the Hospital accompanied by her mother because of labor pain that started 5
hours ago. Cervix is dilated 3cm, 50% effaced. Membranes is intact. Fetal Heart Tone is 140
beats per minute. Fetus is in cephalic presentation as revealed in ultrasound. Uterine
contraction is moderate to strong in intensity with duration of 45 seconds and with an interval
of 3 minutes. Upon assessment bladder is distended. She was encouraged to void. Place on NPO
while in active labor. IVF of D5LR 1L. to run at 30gtts/min..

Belle presented her laboratories results as follows:

1. CBC
A. Hgb __________ 142g/L
B. Hct __________ 0.41 Vol. Fr
C. RBC __________ 4.41 x 10ͮ^12/L
D. WBC __________ 6.4 x 10^g/L

1. Urinalysis

Physical Properties
Color Straw
Transparency Hazy
Reaction 5.0 (acidity)
Specific Gravity 1.025
Chemical Tests
Sugar Negative
Albumin Negative
Microscopic Findings
Pus Cells Occasional 0-3
RBC Occasional 2-4

Vital Signs revealed as follows;

Temperature 37.1°C
Pulse Rate 88 bpm
Respiratory Rate 20 cpm
Blood Pressure 130/80 mmHg
FHB 140 bpm

Belle hold her abdomen, screams and shout, “Why does this hurt so badly”, I wish my
boyfriend is here.

After 3-4 hours from admission Belle complains of increased uterine contractions.With
intensity occurring every 2-3 min. and with a duration of 60-70sec. Bloody show and rupture of
the membranes noted. Internal examination done revealed 10 cm. cervical dilatation.
Belle transferred to delivery room per stretcher. She complaints the urge of bearing down.
After an hour she delivered to an alive baby girl via NSVD.
Questions:

1. Interpret the vaginal examination done to Belle when she came in the lying in clinic based on the
record presented in the scenario (3cm, 50%effaced).
2. Ultrasound of Belle revealed cephalic presentation. Explain cephalic presentation? 3. Belle’s
duration of uterine contraction lasted 45 seconds with an interval of 3 minutes. Discuss the stages
and phases of labor she experienced.
4. Why do we advise the mother on NPO during labor?
5. FHR was checked and revealed 140 beats per minute. What is a normal fetal heart rate during
labor?
6. Ms. Belle presented her laboratories. What is the normal reference value? Discuss the
significance if it is elevated and decreased result during pregnancy.
7. State and discuss psychological behaviour presented in the scenario as verbalized by Ms. Belle.
8. Identify and discuss the stage of labor in the progress of uterine contractions of Ms Belle
presented in the case scenario.
9. As crowning occur, is episiotomy applicable to Ms. Belle? Why?
10. What is Ritgen Maneuver? Explain the indication in performing Rirgen Manuever?
11. Enumerate and briefly discuss the 2 types of episiotomy
12. Explain are the mechanisms of labor?
13. Enumerate and explain the signs of placental separation.
14. 13Formulate a nursing care plan base on Ms. Belle
15. Base on this findings formulate 2 nursing diagnosis