Republic of the philippines

City of Olongapo
GORDON COLLEGE
COLLEGE OF ALLIED HEALTH STUDIES
Olongapo City Sports complex, D0nor St. East Tapinac, Olongapo City 2020
Telefax No.:(047) 602 -7175 loc 318
www.gordoncollege.edu.ph

BACHELOR OF SCIENCE IN MIDWIFERY

A Case Study of 18 years old G1 P1 (1-0-0-1) PU, 38 6/7 weeks AOG Delivered
Spontaneously to a live baby boy via Right Mediolateral
Episotomy repaired with a BW of 3.2 kg,
BL of 45cm and AS of 8,9

In Partial Fulfillment of the Course Requirement

In Clinical Practicum 204

Elaine S. Dalindin
2023
 Republic of the philippines
City of Olongapo
GORDON COLLEGE
COLLEGE OF ALLIED HEALTH STUDIES
Olongapo City Sports complex, D0nor St. East Tapinac, Olongapo City 2020
Telefax No.:(047) 602 -7175 loc 318
www.gordoncollege.edu.ph

Introduction

Pregnancy is the state of carrying a developing embryo or fetus within the

female body. This condition can be indicated by positive results on an over-the-counter
urine test, and confirmed through a blood test, ultrasound, detection of fetal
heartbeat, or an X-ray. Pregnancy lasts for about nine months, measured from the
date of the woman’s last menstrual period (LMP). It is conventionally divided into
three trimesters, each roughly three months long.
When gestation has completed, it goes through a process called delivery, where
the developed fetus is expelled from the mother’s womb. There are two options
of delivery: Cesarean section and NSVD or normal spontaneous vaginal delivery. A
cesarean section is a surgical incision through the mother’s abdomen and uterus to
deliver one or more fetuses. NSVD or normal spontaneous vaginal delivery is the
delivery of the baby through vaginal route. It can also be called NSD or normal
spontaneous delivery.
During a normal labor as the gradual subjugation and dilatation of the cervix as a
result of rhythmic uterine contractions leading to the expulsion of the products of
conception on the delivery of the fetus, membranes, umbilical cord, and placenta.
Labor cannot that be easy; thereby implicating that there are processes and
stages to be undertaken to achieve spontaneous delivery. Through which, Obstetrics
have divided labor into four (4) stages thereby explaining this continuous process. First
stage begins with the initiation of true labor contractions and ends when the cervix is
fully dilated. In the second stage, it is the period from full dilatation and cervical
effacement to the birth of the infant. Next on the third stage, it is also called the
placental stage that begins after the birth of the infant and ends with the delivery of the
placenta. After delivery of the baby. And lastly, on the fourth stage or also called as the
postpartum, it begins right after the placental delivery and ends with the recovery of the
mother from the delivery.
Patients in their first pregnancy tend to need an episiotomy more than patients
in their second or subsequent pregnancies. This is because the perineum is less elastic
and thus, less able to stretch to accommodate the delivering head. An episiotomy is a
cut (incision) made in the tissue between the vaginal opening and the anus during
childbirth. This area is called the perineum. For years, an episiotomy was thought to
help prevent larger vaginal tears during childbirth. Experts believed an incision would
heal better than a natural tear. The procedure was also thought to help preserve the
muscles and connective tissue that support the pelvic floor. However Routine
episiotomies are no longer recommended. Still, the procedure is sometimes needed. An
incision might be recommended if a baby needs to be quickly delivered because: (1)
The baby's shoulder is stuck behind the pelvic bone. (2) The baby has an unusual heart
 Republic of the philippines
City of Olongapo
GORDON COLLEGE
COLLEGE OF ALLIED HEALTH STUDIES
Olongapo City Sports complex, D0nor St. East Tapinac, Olongapo City 2020
Telefax No.:(047) 602 -7175 loc 318
www.gordoncollege.edu.ph

rate pattern during delivery (3) Forceps or vacuum extraction is needed during a vaginal
delivery. There are two types of episiotomy incisions. First, Midline incision. a midline
incision is done vertically. A midline incision is easier to repair. But it has a higher risk of
extending into the anal area. Second is Mediolateral incision, a mediolateral incision is
done at an angle. It is less likely to result in an extended tear into the anal area.
However, this incision is often more painful and more difficult to repair.
Mediolateral episiotomy reduces risk for obstetric anal sphincter injury among
nulliparous women having an operative vaginal delivery with either forceps or vacuum.
Given current practice guidelines, this may be the main maternal indication for
considering an episiotomy.
 Republic of the philippines
City of Olongapo
GORDON COLLEGE
COLLEGE OF ALLIED HEALTH STUDIES
Olongapo City Sports complex, D0nor St. East Tapinac, Olongapo City 2020
Telefax No.:(047) 602 -7175 loc 318
www.gordoncollege.edu.ph

Patient Profile

Patient T is a 18 year old G1P0 (0-0-0-0) she is a resident of Subic Zambales.

Patient T is admitted to San Marcelino District Hospital on February 14, 2023 at 12:25
pm with chief complaint of labor pain . Upon interview Patient L verbalized that her last
menstrual period was May 18, 2022.
Patient T has no severe childhood illness and disease, such as hypertension,
heart disease or asthma in her past. She has no allergy in food or medication.
Patient T is a non-smoker and non-alcoholic drinker. She already had 2 doses of
Sinovac Covid-19 vaccine with a first booster of Pfizer.
Patient T experienced her menarche when she was 13 years old. Her
menstruations is a regular cycle with duration of 7 days, from a heavy flow on a first day
and gradually change into moderate to the end and consumes 3-4 pads per day. She
has a sign dysmenorrhea during her menstruation. Her coitarche happened at the age
17 years old, with only one partner and she has no current or history of sexually
transmitted diseases.
Her admitting diagnosis was 18 years old G1P0 (0000) PU 38 6/7 weeks AOG
cephalic in labor.
 Republic of the philippines
City of Olongapo
GORDON COLLEGE
COLLEGE OF ALLIED HEALTH STUDIES
Olongapo City Sports complex, D0nor St. East Tapinac, Olongapo City 2020
Telefax No.:(047) 602 -7175 loc 318
www.gordoncollege.edu.ph

Course in the Ward

Day 1 February 14, 2023

At 12:25 pm
Patient T is a 18 year old G1P0 (0-0-0-0) she is a resident of Subic Zambales.
Patient T is admitted to San Marcelino District Hospital on February 14, 2023 at 12:25
pm with chief complaint of labor pain . Upon interview Patient L verbalized that her last
menstrual period was May 18, 2022. Patient T has no severe childhood illness and
disease, such as hypertension, heart disease or asthma in her past. She has no allergy
in food or medication. Patient T is a non-smoker and non-alcoholic drinker. She already
had 2 doses of Sinovac Covid-19 vaccine with a first booster of Pfizer. Patient T
experienced her menarche when she was 13 years old. Her menstruations is a regular
cycle with duration of 7 days, from a heavy flow on a first day and gradually change into
moderate to the end and consumes 3-4 pads per day. She has a sign dysmenorrhea
during her menstruation. Her coitarche happened at the age 17 years old, with only one
partner and she has no current or history of sexually transmitted diseases.
Patient T does not have any Covid-19 related symptoms and she was transferred
via wheel chair from triage to emergency room accompanied by a nurse. Upon
admission she was conscious, coherent, can recognize things and response to the
questions she was being asked. Upon physical examination, it was determined that she
is already 5cm, 50% effaced, intact bag of water with a fundic height of 29cm. Abdomen
is globular with good fetal movement and FHT of 135 /min.

At 12:33 pm
Patient T was admitted to labor room under the service of Dr. Alvezo. Consent was
signed and secured. Patient T was ordered nothing per orem and monitor vital signs
every hour while in active labor. D5LRS Intravenous fluid inserted at Patient T left
cephalic vein, 1 liter to run for 8 hours with regulation of 30gtts. Laboratories were
requested such as CBC, blood typing, HBsAg, RPR, and urinalysis. Patient T vital signs
was blood pressure of 110/70, pulse rate of 114, respiration rate of 20, and temperature
of 36.0C.
 Republic of the philippines
City of Olongapo
GORDON COLLEGE
COLLEGE OF ALLIED HEALTH STUDIES
Olongapo City Sports complex, D0nor St. East Tapinac, Olongapo City 2020
Telefax No.:(047) 602 -7175 loc 318
www.gordoncollege.edu.ph

At 1:30 pm
Patient T is conscious, coherent, and still in labor with regular contraction. Internal
examination was reapeted and it revealed 6-7 cervical dilatation with FHT of 138 bpm.

Laboratory test result released follows:

HEMATOLOGY
EXAMINATION RESULT REFERENCE VALUE
BLOOD TYPE “O+” Rh (+)
HEMOGLOBIN 110 M: 140-180
F: 120-150
HEMTOCRIT 0.34 M: 0.40-0.50
F: 0.30-0.40
WBC 8.98 5.0-10×109 /L
NEUTROPHILS 68.0 0.30-0.70
LYMPHOCYTES 23.0 0.20-0.40
MONOCYTES 6.0 0.02-0.10
EOSINOPHILS 1.0 0.01-0.06
PLATELETS 278 150-350×109/L
RBC 3.83 PEDIA 3.3-5.4×109/L
ADULT 4.6-6.0×109/L
Interpretation: Patient T hemoglobin and RBC was lower than normal range.

IMMUNOLOGY AND SEROLOGY

HBsAg NON REACTIVE
RPR NON REACTIVE
Interpretation: Patient T does not have hepatitis B infection and syphilis.

At 2:30 pm
Repeat internal examination by midwife on duty, revealed as cervical dilatation of 7 cm,
75% effaced, (-) BOW, cephalic presentation, station 0, with FHT of 159 bpm. Her vital
signs were also taken, blood pressure of 110/70, pulse rate of 82, respiration rate of 19,
and temperature of 36.3 C.
 Republic of the philippines
City of Olongapo
GORDON COLLEGE
COLLEGE OF ALLIED HEALTH STUDIES
Olongapo City Sports complex, D0nor St. East Tapinac, Olongapo City 2020
Telefax No.:(047) 602 -7175 loc 318
www.gordoncollege.edu.ph

Laboratory test result released follows:

AUTOMATED URINE MICROSCOPY
PARAMETERS RESULT
Physical Examination

Color LIGHT YELLOW

Transparency SLIGHTLY CLOUDY
Chemical analysis

Ketone

Glucose Negative
Protein Negative
pH 6.5
Specific Gravity 1.015
PARAMETERS RESULT REFERENCE RANGE
WBC 0.90 0 -5
RBC 0.20 0 - 1.14
Epithelial Cells FEW 0 - 1.14
Cast 0–1

Bacteria FEW 0 -29.55

Mucus Threads RARE 0 – 60

Interpretation: All laboratory test are normal except for bacteria and epithelial cells,
there is a few in findings.

At 3:30 pm
Upon transferring of patient T to the Delivery Room, she was assisted to delivery table
and positioned her in dorsal recumbent position. Continues monitoring her vital signs
with ongoing D5LRS x 30 gtts. Internal examination revealed 10cm cervix, fully dilated
100% effaced. Patient T started to bear down.

At 3:43 pm
Patient T delivered spontaneously to a live baby boy via right mediolateral episotomy.

At 3:48 pm
Placenta has been delivered completely.
 Republic of the philippines
City of Olongapo
GORDON COLLEGE
COLLEGE OF ALLIED HEALTH STUDIES
Olongapo City Sports complex, D0nor St. East Tapinac, Olongapo City 2020
Telefax No.:(047) 602 -7175 loc 318
www.gordoncollege.edu.ph

At 3;49 pm
1 ampule of oxytocin was given intramuscularly.

At 3:56 pm
Patient T uterus was well contracted, right mediolateral episiotomy was repaired,
layered by layered, bleeding was noted. As the doctor’s order to monitor her vital signs
every 15 minutes per hour until her condition were stabilized and postpartum care
rendered. Patient T was transferred from delivery Room to Recovery Room assisted by
nurse with a stretcher

Continue monitoring of vital signs every 15 minuutes as follows:

DATE/SHIFT TIME BP CR RR TEMP
2-14-23 4:00 pm 110/70 76 19 36.4
4:15 pm 110/80 80 19 36.4
4:30 pm 120/80 84 20 36.6
4:45 pm 120/80 83 20 36.6

At 4:45 pm
Change dressing was done. Patient was awake and coherent and was provided comfort
and health teaching, perineal care is also advised. Patient T was transfer from Recovery
Room to OB Ward via stretcher assisted by the nurse on duty.
 Republic of the philippines
City of Olongapo
GORDON COLLEGE
COLLEGE OF ALLIED HEALTH STUDIES
Olongapo City Sports complex, D0nor St. East Tapinac, Olongapo City 2020
Telefax No.:(047) 602 -7175 loc 318
www.gordoncollege.edu.ph

Drug Study

PRENATAL MEDICATION
DRUG DOSE ROUTE INDICATIO HOW DOES IT SIDE
S N APLLIED TO EFFECTS
YOUR PATIENT?
Folic 400mc oral Can lower Folic acid can Nausea
acid g neural tube prevent birth Loss of
defect risks defects known as appetite
neural tube defects, Bloating
including spinal
bifida
Ferrous 350mc oral Prevent iron Ferrous sulphate Nausea
sulfate g deficiency used to treat and Loss of
Anemia and prevent iron appetite
deficiency anemia Constipation
Diarrhea
Dark stool

VACCINE
DRUGS DOSE ROUTE INDICATIO HOW DOES SIDE
N IT APLLIED EFFECTS
TO YOUR
PATIENT?
Tetanus 0.05 Intramuscula Protect fetus Tetanus Muscle ache
toxoid 1 and r from toxoid given and redness
2 neonatal to a mother of the
tetanus as a vaccine injection site
to protect
her child
from tetanus
neonatorum
that cause
infant
mortality
 Republic of the philippines
City of Olongapo
GORDON COLLEGE
COLLEGE OF ALLIED HEALTH STUDIES
Olongapo City Sports complex, D0nor St. East Tapinac, Olongapo City 2020
Telefax No.:(047) 602 -7175 loc 318
www.gordoncollege.edu.ph

INTRAPARTUM MEDICATION
DRUGS DOSE ROUTE INDICATIO HOW SIDE
N DOES IT EFFECTS
APLLIED
TO YOUR
PATIENT
?
Oxytocin 10 units IVF Oxytocin is a Helps May cause
incorporate oxytocic drug prevent sudden drop of
that helps postpartum blood pressure
uterus to hemorrhag
contract after e it
child birth promotes
contraction
of uterine
muscle

POSTPARTUM MEDICATION
DRUGS DOSE ROUTE INDICATIO HOW SIDE
N DOES IT EFFECTS
APLLIED
TO YOUR
PATIENT
Co-amoxiclav 625 mg Oral Used as Treat wide Diarrhea
1 tablet antibiotic range of Thrush
bacterial Nausea
infections
Mefenamic 500 mg Oral Relieve mild treat mild to Bloody urine
acid 1 to moderate moderate and stool
capsule pain pain and Heartburn
prevents or Hypertension
lessens
inflammatio
n in the bod
Ferrous 1 Oral Prevent iron Helps body Nausea
 Republic of the philippines
City of Olongapo
GORDON COLLEGE
COLLEGE OF ALLIED HEALTH STUDIES
Olongapo City Sports complex, D0nor St. East Tapinac, Olongapo City 2020
Telefax No.:(047) 602 -7175 loc 318
www.gordoncollege.edu.ph

fumarate capsule deficiency make Stomach

anemia healthy red Discomfort
blood cells Constipation
after child
birth

INTRAVENOUS FLUID
DRUGS DOSE ROUTE INDICATION HOW DOES SIDE
IT APLLIED EFFECTS
TO YOUR
PATIENT
It helps
prevent
dehydration
in terms of
obstetrical Phlebitis,
Used in
emergencies redness of
D5LRS 1 Liter Intravenous obstetrical
it acts as insertion site,
emergencies.
intravenous and bruising.
fluid can also
be a way to
receive
medications.
 Republic of the philippines
City of Olongapo
GORDON COLLEGE
COLLEGE OF ALLIED HEALTH STUDIES
Olongapo City Sports complex, D0nor St. East Tapinac, Olongapo City 2020
Telefax No.:(047) 602 -7175 loc 318
www.gordoncollege.edu.ph

CONCLUSION

Patient T is 18 years old, residing at Subic, Zambales. With the age of gestation
of 38 6/7 weeks. Last menstruation was May 18, 2022 and expected date delivery on
February 25, 2023. She had menarche when she was 13 years old with regular
menstrual cycle, moderate menstrual flow that last 7 days, consuming 3-4 pads per day
with positive sign of dysmenorrhea. Her coitarche happened at the age of 17. She only
has 1 partner and no history of sexual transmitted disease. Had her regular check-up at
San Agustin Health Center. She took folic acid supplements in daily basis. During
prenatal visits, there is no complains noted. She is non-smoker and non-alcohol drinker
She came to triage of San Marcelino District Hospital with a chief complaint of
labor pain. She was admitted under the service of Dr. Alvezo on February 14, 2023.
Patient T laboratory results shows that she does not have hepatitis B infection, syphilis
and her complete blood count was all within normal value. Upon to the Delivery Room,
she was assisted to delivery table and positioned her in dorsal recumbent position.
Continues monitoring her vital signs with ongoing D5LRS x 30 gtts. Internal examination
revealed 10cm cervix, fully dilated 100% effaced. Patient T started to bear down. She
delivered spontaneously to a live baby boy via right mediolateral episiotomy with a birth
weight of 3.2 kg birth length of 45 cm and an Apgar Score of 8,9. The placenta was
completely delivered, 1 ampule of oxytocin and was given intramuscularly. She has no
abnormal postpartum bleeding and perineal care was done. She was transferred to
ward awake and coherent.
Patients T was in her first pregnancy, in her case, first pregnancy tend to need an
episiotomy more than patients in their second or subsequent pregnancies. This is
because the perineum is less elastic and thus, less able to stretch to accommodate the
delivering head. She delivered spontaneously via right mediolateral episiotomy. A
mediolateral incision is done at an angle. It is less likely to result in an extended tear
into the anal area. Mediolateral episiotomy reduces risk for obstetric anal sphincter
injury among nulliparous women having an operative vaginal delivery with either forceps
or vacuum. Given current practice guidelines, this may be the main maternal indication
for considering an episiotomy.
 Republic of the philippines
City of Olongapo
GORDON COLLEGE
COLLEGE OF ALLIED HEALTH STUDIES
Olongapo City Sports complex, D0nor St. East Tapinac, Olongapo City 2020
Telefax No.:(047) 602 -7175 loc 318
www.gordoncollege.edu.ph

RECOMMENDATION
Patient T is a young primi so I recommend to have her undergo for counselling
for family planning, to find what is best and suitable for them. She and her partner can
decide whatever they want to use and practice to limit/spacing the size of their family.
Since the mother’s body has undergone to changes during pregnancy and birth. I
recommend the mother to take a rest in complete one week. She needs to relieve in all
responsibility other than feeding the baby and taking care of herself. In addition, for
recovery she need to eat healthy and balance diet so she can be active and able to take
care of her baby. Foods that are advisable for breast feeding mothers are: fish and
seafood, meat, fruits and vegetables, nut and seed, and some other foods. I also
recommend maintaining perineal hygiene to prevent spread of bacteria that can cause
infection and foul smell, specifically clean the sutured area
As for the baby,I recommend to learn the basic knowledge how to take good
care of their baby. She must exclusively breastfeeding since breast milk contains
everything a baby requires for proper development during the first six months of life.
Breastfeed the baby every 2 hours and avoid feeding them in supine position. Feed the
baby in standing or sitting position. Make them burp in midway and after feeding to help
prevent the milk from coming back up. Mother should also expose their baby to sunlight
between 7:00-8:00 in the morning at least 10-15 minutes. Sunlight exposure helps the
body to absorb calcium, also has a function of strengthening bones. Cord care with 70%
alcohol prevents infection. Do this 4x a day until the cord falls. I recommend to take bath
the baby daily with lukewarm and mild baby soap. Mother should watch out for these
signs: fever, cough, onset or progression jaundice. Redness or discharge around
umbilicus. If any of these signs shown up, take the baby to nearest hospital or health
center. Also observe for poor suck and decrease activity. Lastly, for follow up, mother
with her baby can go to the nearest hospital or health center for vaccination.