Patient’s Profile:

Hospital: Ilocos Training and Regional Medical Center

Name: Mrs.

Address: Canan (Gapan), La paz, Abra

Birthdate: April 2, 1984

Birthplace: La Paz, Abra

Age: 39 y/o

Gender: Female

Civil Status: Married

Religion: Roman Catholic

Occupation: Housewife

Citizenship: Filipino

Chief Complaints: N/A

Duration: N/A

Date and time of Admission: 02/02/2023 08:28 AM

Admission Diagnosis:

Final Diagnosis:

Admitting Physician: Hagacer, Grethel Joy D., MD, FPOGS, FPSMFM

Attending Physician: Castro, Andrea Victoria M., MD

Operation done: N/A

Ward:
Objectives:
 To acquire more knowledge regarding Normal Spontaneous Pregnancy, its definition,

risk actors, signs and symptoms, complications and incidence.

 Outline the typical course of a patient undergoing vaginal delivery.

 Identify the most common adverse events associated with vaginal delivery.

 Summarize the risks associated with vaginal delivery.

 Explain the importance of improving care coordination amongst the interprofessional

team to enhance the delivery of care for patients undergoing vaginal delivery.

 To know the profile information, to appraise the physical history of past and present

illness, and the Maslow's Hierarchy of needs of the client.

 To review Anatomy and Physiology of the affected system.

 To illustrate the Pathophysiology of Normal Spontaneous Pregnancy

 To identify the ideal and actual Laboratory Tests and Diagnostic Examinations

 To know the ideal and Actual Medical, Nursing and Pharmacological Management and

Treatment.

 To use the Nursing Process as the framework of care the pregnant client.

 To impact appropriate health teaching to the client and significant others.

 To update on the latest issues/ trends of treatment and management of Normal

Spontaneous Pregnancy.

Introduction:
 Pregnancy starts with fertilization, the time when the male's gamete (sperm) has reached

and entered the woman's gamete (ovum/egg cell). The ovum is the female sex cell or gamete. It

is regularly released by the ovary through the process of ovulation. Two layers of protective

covering are present in the ovum: the outer layer or the corona radiata and the inner layer or the

zona pellucida. The egg cell has a life span of 24 hours and it can only be fertilized during the

span of this period. After 24 hours, it regresses and be resorbed.

The sperm cell is the male cell gamete. It mainly has three part: the head which contains

the chromatin materials. the mid-piece that serves as the center for energy production and the tail

that is responsible for its motility. The sperm cell has a life span of 48 to 72 hours. approximately

3 to 4 days after ejaculation. The sperm must be in the genital tract for 4 to 6 order to fertilize an

ovum to give time the enzyme to be activated. There are two of sperm cell called Gymnosperm

and Androsperm (Rkhardson, 2009). The Gymnosperm is X carrying sperm cell. has a large oval

and are lesser in number that androsperms and they thrive better in acidic environment. The

androsperm, on the other hand, carries the Y chromosome with a small head and thrive better in

alkaline environment.

The zygote travels before fertilization, Insemination has to happen first. Insemination is

the deposition of the sperm cell in the female reproductive tract which occur during sexual

intercourse. Although millions of sperm cells are deposited in the vagina, only a few reach the

uterus because many of them are immobilized by the acidic vaginal environment. The

spermatozoa swims so fast that within 90 seconds it is already in the uterus and reaches the

fallopian tube within 5 minutes after deposition.

After insemination, fertilization occurs. It is the union of the ovum and sperm, usually

occurring in the ampulla of the uterine tube. It is also the start of mitotic cell division and fetal
sex determination. The result of this union is called a zygote cell or the fertilized egg, initiating

prenatal development. The zygote travels from the uterine tube by being brushed by the hair-like

cilia in the tube toward the uterus that takes 3 to 4 days, where it becomes implanted. 24 hours

after fertilization, the zygote undergoes its first cell division (blastomeres). Subsequent cell

division occur after 22 hours. When there are already 16 or more blastomeres, the zygote is now

termed "morula". The morula travels from the uterine tube to the uterus and upon reaching the

uterine cavity, the remaining zona pellucida disintegrate and transforms into blastocyst.

Blastocyst, a ball like structure composed of inner cell mass called embryonic disc or

blastocoel, occupies one of its poles and an outer layer rapidly develops a cell called

trophoblast/trophoderm. The trophoderm layer gives rise to the placenta, fetal membrane,

umbilical cord, and the amniotic fluid.

This process will be followed by an event called Implantation which takes place in the

endometrium 6 to 7 days after the fertilization. Its trophoblast cell release enzymes that digest

endometrial cell at the area of implantation that causes the rupture of several capillaries, resulting

in bleeding at the implantation site. This event called the rupture of several endometrial blood

vessels is the cause of vaginal bleeding experienced by some woman at the time of implantation,

the Implantation Bleeding. The ideal site of fertilization is the fundal portion.

At around the third week of gestation, the trophoblast cell surrounding the blastocyst

differentiate in two distinct layers called the Cytotrophoblast and the Syncytiotrophoblast The

Cytotrophoblast is the first layer that develops and is called the Langhan's layer because it is

composed of cells with well differentiated and clear cytoplasm. (Benson. 1994) This layer

protects the fetus from Treponema pallidum or simply, syphilis. But it only protects until the

second trimester of pregnancy because after the third month of pregnancy, the cells of
cytotrophoblasts come less numerous, making it an ineffective barrier anymore against syphilis.

On the Other hand, the is an outer layer which originated from the cytotrophoblast that is

composed of multinucleated cells without cell boundaries. During the second trimester, only a

small amount of cytotrophoblast cells remains, so that it is the syncytium that functions as the

primary barrier. However, it is only a poor barrier being composed of a single layer of cells that

is capable of blocking completely only a limited number of molecular weight substances such as

insulin and HCG.

As early as 12 days after fertilization. the trophoblast cells rapidly multiply and mature to

as either Chorlon Frondosum and the Chorlon Lane. The chorion frondosum are the chorionic in

contact with decidua basalis that proliferate rapidly because they receive rich blood supply from

the uterus. They will later form the fetal side of the placenta. These villi are responsible for

absorbing nutrients and oxygen from maternal blood stream and disposing of fetal waste

products including carbon dioxide. The chorion laeve, meanwhile, are the chorionic villi not

involved with implantation that gradually degenerates, becoming very thin and eventually

forming the chorionic membrane. These villi are also referred to as the bald chorion.

Due to its abundant blood supply, which enables optimal placental growth and

development, the endometrium is now referred to as the decidua after implantation, making it the

specially designed endometrium for pregnancy. Due to its continuous connection to the birth

canal, it also makes it simple to deliver the baby at the conclusion of gestation. Being placed in

the decidua shields it from cervical and vaginal infection. Prolactin, relaxin, corticotropin-

releasing hormone (CRH), prostaglandin, oxytocin, and endothelin are some of the other specific

hormones that it generates.

The development of the fetal membranes, which serve to encapsulate the embryo and the

amniotic fluid, occurs next. and to shield the unborn child from bacterial illnesses as long as it is

still alive. The chorionic membrane and the amniotic membrane are the two types of fetal

membranes. While the amniotic membrane covers the umbilical cord and the fetal surface of the

placenta, giving it a glossy look, the chorionic membrane supports the amniotic membrane. The

amniotic membrane is a smooth, thin, tough, and translucent membrane directly covering and

enclosing the fetus and the amniotic fluid These two are also called the chorion and the amnion.

They both don't possess a nerve supply and blood vessels so that the mother and the fetus will

not experience pain or blood loss when they rupture.

These series of events are the process of the conception. Now take a closer look on the

products of the conception. The first one is the amniotic fluid. Amniotic fluid is the medium

through which the fetus and the cord float inside the amniotic membrane. It is not in a static state

but is a continuous turn over, 350-500 ml of it is produced each hour (Evangelista. 1995).

https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo