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Case 1

Here are the key details from the case: - Mrs. S is a 28 year old G2P1 at 38 weeks gestation who presents with decreased fetal movements over the past 12 hours. - On examination: Fetal heart rate is 120 bpm Uterus is relaxed Fetal parts cannot be palpated - Ultrasound shows: Fetal biophysical profile of 2/8 (no movement, no breathing movements) Amniotic fluid is decreased - Decision is made for an emergency lower segment cesarean section. - A macerated stillborn female infant weighing 2.6kg is delivered. Placenta shows evidence of ab

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Akanksha Rawat
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163 views

Case 1

Here are the key details from the case: - Mrs. S is a 28 year old G2P1 at 38 weeks gestation who presents with decreased fetal movements over the past 12 hours. - On examination: Fetal heart rate is 120 bpm Uterus is relaxed Fetal parts cannot be palpated - Ultrasound shows: Fetal biophysical profile of 2/8 (no movement, no breathing movements) Amniotic fluid is decreased - Decision is made for an emergency lower segment cesarean section. - A macerated stillborn female infant weighing 2.6kg is delivered. Placenta shows evidence of ab

Uploaded by

Akanksha Rawat
Copyright
© © All Rights Reserved
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Case 1

Nkosi is a gravida 5, para 4 mother, whose current pregnancy has reached the gestational age of 40
weeks and 4 days. When you arrive at her house, she is already in labour. During your first
assessment, she had four contractions in 10 minutes, each lasting 35–40 seconds. On vaginal
examination, the fetal head was at –3 station and Nkosi’s cervix was dilated to 5 cm. The fetal heart
rate at the first count was 144 beats/min.

1. What does it mean to say that Nkosi is a ‘gravida 5, para 4 mother’?


2. How would you describe the gestational age of Nkosi’s baby?
3. Which stage of labour has she reached and is the baby’s head engaged yet?
4. Is the fetal heart rate normal or abnormal?
5. .What would you do to monitor the progress of Nkosi’s labour?
6. Give two reasons for using a partograph.

7. What indicators of good progress of labour would you record on the partograph?
8. What indicators of fetal wellbeing would you record on the partograph?
9. How often should you measure the vital signs of the mother and record them on the
partograph in a normally progressing labour? 
10. What are the key indicators for immediate referral?
CASE 2
STEP 1. Mrs. C was admitted at 10.00 on 19 September 2013. Membranes ruptured spontaneously at 04.00.
She is a gravida 4, para 3+0. Her hospital number is 6639.

Record the information above on the partogram, together with the following details:
 Fetal head 3/5 palpable above the symphysis pubis
 Cervix 4 cm dilated
 3 contractions in 10 minutes, each lasting 30 seconds
 FHR 140
 Amniotic fluid clear
 Sutures apposed (Molding +)
 Blood pressure 120/70 mmHg
 Temperature 36.8°C
 Pulse 80/minute

STEP 2. Plot the following information in the partogram:


 10.30 FHR 130, Contractions 3/10 each 45 seconds, Pulse 80/minute
 11.00 FHR 136, Contractions 3/10 each 45 seconds, Pulse 90/minute
 11.30 FHR 140, Contractions 3/10 each 45 seconds, Pulse 88/minute
 12.00 FHR 140, Contractions 3/10 each 45 seconds, Pulse 90/minute, Temperature 37°C, Head 3/5
palpable
 12.30 FHR 130, Contractions 3/10 each 45 seconds, Pulse 90/minute
 13.00 FHR 130, Contractions 3/10 each 50 seconds, Pulse 88/minute
 13.30 FHR 120, Contractions 3/10 each 50 seconds, Pulse 88/minute
 14.00 FHR 130, Contractions 3/10 each 50 seconds, Pulse 90/minute, Temperature 37°C, Blood
Pressure 100/70 mmHg. Fetal head 3/5 palpable above the symphysis pubis. Cervix 6 cm dilated,
amniotic fluid clear. Sutures overlapped but reducible (Molding ++).
STEP 3. Plot the following information in the partogram:
 14.30 FHR 120, Contractions 3/10 each 45 seconds, Pulse 90/minute, Clear fluid
 15.00 FHR 120, Contractions 3/10 each 45 seconds, Pulse 88/minute, Blood-stained fluid
 15.30 FHR 100, Contractions 3/10 each 45 seconds, Pulse 100/minute
 16.00 FHR 90, Contractions 3/10 each 50 seconds, Pulse 100/minute, Temperature 37°C
 16.30 FHR 96, Contractions 4/10 each 50 seconds, Pulse 110/minute. Fetal head 3/5 palpable
above the symphysis pubis. Cervix 6 cm dilated. Amniotic fluid meconium stained. Sutures
overlapped and not reducible. Urine output 100 mL; protein negative, acetone 1+.

STEP 4. Record the following information on the partogram:


 Cesarean section at 17.30, live female infant with poor respiratory effort and weighing 4,850 g.

Answer the following questions:

Q: What is the final diagnosis?

Q: What action was indicated at 14.00, and why?


Q: What action was indicated at 15.00, and why?

Q: At 17.00, a decision was taken to do a cesarean section, and this was rapidly done. Was this a correct
action?

Q: What problems may be expected in the newborn?


CASE 3

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