WESLEYAN UNIVERSITY PHILIPPINES CABANATUAN CITY

A Case Study of Cesarean Delivery (Breech Presentation )

Submitted by: ERIKA JOY A. IMPERIO BSN 3-6 Submitted to: Maam FITZEE PATACSIL

Clinical Instructor

PATIENTS PROFILE Name: Age: Gender: Civil Status: Nationality: Address: Religion: Patient RMJ 28 years old Female Married Filipino 9179 J.M. Loyola Street Maduya Carmona Cavite Roman Catholic

Date of Birth: August 02, 1981

Attending Physician: Date of Admission: Final Diagnosis:

Dr. Brilliantes July 16, 2010 (5:30am) PUFT Cephalic in Labor with alive Baby Boy G2P2 (2002) Previous CS on Breech Presentation chief complain: For CS

Patients History:

History: Patient came schedule for CS. No hypogastric pain, Vaginal bleeding, ruptured BOW, vomiting Physical Examination: - Conscious and coherent - Warm , good skin turgor - Anecentric sclera, pink

ANATOMY AND PHYSIOLOGY

ANATOMY AND PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM

EXTERNAL GENITALIA

Our overview of the reproductive system begins at the external genital area or vulvawhich runs from the pubic area downward to the rectum. Two folds of fatty, fleshy tissue surround the entrance to the vagina and the urinary opening: the labia majora, or outer folds, and the labia minora, or inner folds,

located under the labia majora. The clitoris, is a relatively short organ (less than one inch long), shielded by a hood of flesh. When stimulated sexually, the clitoris can become erect like a man's penis. The hymen, a thin membrane protecting the entrance of the vagina, stretches when you insert a tampon or have intercourse.

INTERNAL REPRODUCTIVE STRUCTURE

The Vagina The vagina is a muscular, ridged sheath connecting the external genitals to the uterus, where the embryo grows into a fetus during pregnancy. In the reproductive process, the vagina functions as a two-way street, accepting the penis and sperm during intercourse and roughly nine months later, serving as the avenue of birth through which the new baby enters the world . The Cervix The vagina ends at the cervix, the lower portion or neck of the uterus. Like the vagina, the cervix has dual reproductive functions.

After intercourse, sperm ejaculated in the vagina pass through the cervix, then proceed through the uterus to the fallopian tubes where, if a sperm encounters an ovum (egg), conception occurs. The cervix is lined with mucus, the quality and quantity of which is governed by monthly fluctuations in the levels of the two principle sex hormones, estrogen and progesterone. When estrogen levels are low, the mucus tends to be thick and sparse, which makes it difficult for sperm to reach the fallopian tubes. But when an egg is ready for fertilization and estrogen levels are high the mucus then becomes thin and slippery, offering a much more friendly environment to sperm as they struggle towards their goal. (This phenomenon is employed by birth control pills, shots and implants. One of the ways they prevent conception is to render the cervical mucus thick, sparse, and hostile to sperm.) Uterus The uterus or womb is the major female reproductive organ of humans. One end, the cervix, opens into the vagina; the other is connected on both sides to the fallopian tubes.
The uterus mostly consists of muscle, known as myometrium. Its major function is to accept a fertilized ovum which becomes implanted into the endometrium, and derives nourishment from blood vessels which develop exclusively for this purpose. The fertilized ovum becomes an embryo, develops into a fetus and gestates until childbirth.

Oviducts The Fallopian tubes or oviducts are two very fine tubes leading from the ovaries of female mammals into the uterus. On maturity of an ovum, the follicle and the ovary's wall rupture, allowing the ovum to escape and enter the Fallopian tube. There it travels toward the uterus, pushed along by movements of cilia on the inner lining of the tubes. This trip takes hours or days. If the ovum is fertilized while in the Fallopian tube, then it normally implants in the endometrium when it reaches the uterus, which signals the beginning of pregnancy. Ovaries The ovaries are the place inside the female body where ova or eggs are produced. The process by which the ovum is released is called ovulation. The speed of ovulation is periodic and impacts directly to the length of a menstrual cycle. After ovulation, the ovum is captured by the oviduct, where it travelled down the oviduct to the uterus, occasionally being fertilised on its way by an

incoming sperm, leading to pregnancy and the eventual birth of a new human being. The Fallopian tubes are often called the oviducts and they have small hairs (cilia) to help the egg cell travel.

INDICATIONS FOR THE PROCEDURE

CAESARIAN SECTION

A Caesarian section is a form of childbirth in which a surgical incision is made through a mothers abdomen and uterus to deliver one or more babies. It is usually performed when a vaginal delivery would put the babys or mothers life or health at risk; although in recent times it has been also performed upon requests for births that would otherwise have been normal.

Caesarian section (CS) is recommended when vaginal delivery might pose a risk to the mother or baby. Reasons for CS include: Precious (high risk) fetus Prolonged labor or failureto progress (dystocia Apparent fetal distress Apparent maternal distress Complications (pre-eclampsia, active herpes) Catastrophes such as cord prolapse or uterine rupture

Multiple births Abnormal presentation (breech or transverse positions) Failed induction of labor Failed instrumental delivery The baby is too large (macrosomia) Placental problems (placenta previa, placental abruption/

placenta accrete) Umbilical cord abnormalities Contracted pelvis Sexually transmitted infections such as genital herpes Previous caesarian section Old age Breech Presentation

Breech Presentation Most fetuses are in breech position early in pregnancy. However, by week 38 fetus normally turns to a cephalic presentation. Although the fetal head is widest single diameter, the fetuss buttocks (Breech), plus the legs, actually take up more space. The fact that the fundus is the largest part of the uterus is probably the reason why in approximately 97% of all pregnancies, the fetus turns so that the buttock and lower extremities are in the fundus. There are several types of breech presentation: complete, frank and footling. Breech presentation is more hazardous to a fetus than a cephalic presentation, because there is a higher risk of the following complications: - Anoxia from the prolapsed cord - Traumatic injury to the after coming head - Fracture of the spine of arm - Dysfunctional labor - Early rupture of the membrane because of the poor fit of the presenting part The inevitable contraction of the fetal buttocks from cervical pressure often causes meconium to be extruded into the amniotic fluid before birth. This, unlike meconium staining that occurs due to fetal anoxia, is not a sign of fetal distress but expected from the buttock pressure. Such meconium excretion can however, lead to meconium aspiration if the infant inhales amniotic fluid.

LABORATORY / DIAGNOSTICS

Procedure / Date 1. CBC Hemoglobin

Actual Findings

Normal Findings

Implications

Nursing Responsibilities Pre: Check Doctors Order. Inform client and explain the procedure. No need for NPO.

116

120 140 g/dL

Decrease - Indicates occurrence of

0.30 Hematocrit 0.35 5 - 10 WBC Segmenters Lymphocytes 8.0 0.60 0.14 0.36 - 0.66 0.22 - 0.40

anemia Increase - Indicates hypercoagulation Normal Normal Decrease - Indicates high risk for acquiring infection

Intra: Perform blood extraction (venipuncture technique) using aseptic technique. Put extracted blood in ethyldiaminotetracetate (EDTA) or the lavender top vacuum tube. Post: Label the container properly and correctly. Send specimen to the lab immediately. Document the result to the chart and inform physician that the result is out.

Eosinophils Stab Cells Platelets

0.02 0.04 320

0.01 - 0.04 0.02 - 0.05 150 400x9/L

Normal Normal Normal

URINE ANALYSIS

Microscopic Exam

Chemical Exam

Color: Yellow Transparency: Hazel pH: 6.0 (7.35 7.45) Specific Gravity: 1.010 (1.010 1.025) Epithelial Cells: Moderate

Albumin: Negative Sugar: Negative