ILOILO DOCTORS’ COLLEGE

COLLEGE OF NURSING
West Avenue, Molo, Iloilo City

NCM 107 (RLE)

CARE OF THE MOTHER, CHILD AND ADOLESCENT (WELL CLIENTS)

Case Scenario No.3

Intrapartum: Labor Stage 1

Andrea R., accompanied by her mother, came in the hospital because she is experiencing abdominal pains with
cramping extending to her lower back. She is already at her 37
th
week of gestation.
Andrea is aware that labor has started already and she is ready for admission. She brought with her thelaboratory
examination results that were requested by her obstetrician (See Tables 1,2 and 3 for reference) that will be needed upon
admission.
During assessment, Andrea reported that the labor pains started 5 hours ago. Internal vaginal examination was
done and revealed that her cervix is dilated at 3cm, 50% effaced, with fetal head at (-3) station and membranes are intact.
Uterine contractions are moderate to strong in intensity that are lastingfor 30-40 seconds and usually occurring every 4-5
minutes. Fetal assessment was also done identifyingfetal heart tones heard by stethoscope on the left lower abdominal
quadrant at 140 beats per minute. Thefetus is in cephalic presentation by Leopold’s Maneuver and as revealed in
ultrasound result. Further assessment identified that Andrea’s bladder is distended and was assisted by the nurse to void.
Vital signswere taken with the following results: Temperature=37.1°C, Pulse Rate=88 bpm, Respiratory Rate=20cpm,
Blood Pressure=130/80 mmHg. Intravenous fluid infusion of 1-liter Dextrose 5%in Lactated Ringers Solution + 10 units
Oxytocin was started at 10 gtts/ min and titrated to good uterine contractions. Buscopan 20 mg was given slow IVTT
initially to shorten her labor and allow for cervical effacement toprogress.
Few hours later, Andrea’s labor pain and contractions progressed and she was brought to the labor room for
further monitoring. Internal examination identified that her cervix is 7 cmdilated, 70%effaced with the fetal head at (0)
station. The duration of contractions is already occurring for 60-70seconds, with intervals of approximately 2 minutes
apart and she was placed on NPO while in active labor. While contractions are occurring, Andrea was complaining that
the pain intensity is increasing. Whileholding her abdomen, she shouts and screams loudly, saying, “Why does this hurt
so badly! I wish myboyfriend is here.”
After a while, her bag of water ruptured and bloody show was flowing out fromher vagina toher thighs. She
complaints of the urge of bearing down during this time. Internal examination was done andrevealed a full 10 cm.
cervical dilatation with the fetal head at (+3) station. Andrea R was transferredtodelivery room per stretcher.

LABORATORY RESULTS

Table 1.CBC
RBC
A. Hgb

B. Hct
Table 3. Ultrasound (Biometry) Report
C. RBC Biometric Measurements
D. WBC
BPD (Biparietal Diameter)

HC (Head Circumference)
Table 2. URINALYSIS
Physical Properties

Color

Transparency

Reaction

Specific gravity

Chemical test

Sugar

Albumin

Microscopic Findings

Pus cells
 ILOILO DOCTORS’ COLLEGE COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
3.23 cm
5.47 cm
AC (Abdominal Circumference)

FL (Femur Length) 7.23 cm

Fetal Number Single

FHB 138 bpm

Presentation Cephalic

Gender Male

Placenta on BPD,

Location Posteriolateral, left, high-lying

Estimated Weight 3108 grams

Amniotic Fluid Index 4.95

Total AFI 17.39 3.74

Biophysical Profile Score

Fetal Movements 2 Fetal

Breathing

Fetal Tone 2 Amniotic

Average Age by Ultrasound: 37 weeks, 6 days

Expected Date of Confinement: March 22, 2023

Impression:

Single, Live, Intrauterine Pregnancy in Cephalic

Presentation.Estimated Gestational Age is 37 weeks and 6 days
basedHC, AC and FL.
Posterior Placenta, Grade 1 Maturity.
Normohydramnios.
Biophysical Profile of 8/8.

///edited100722csl