CASE PRESENTATION
NORMAL LABOR
PRESENTER: SHUKRI ABDULLAHI JIMALE
Personal date
• Name: Xaliimo Xasan Ali
• Sex: female
• Age: 24yrs
• Residence: wadajir
• Region: Banaadir
• Occupation: housewife
• Marital status : married
• Gravida: 3
• Parity: 2
• Gestation age: 36weeks + 6days
Chief Complain
• Lower back pain for 12 hr
History Of Presenting ilness
• The patient presents with Acute lower back pain,
Characterized as colicky in nature, with Radiation to the
lower abdomen. The pain occurs regularly but does not
seem to be Aggravated by any specific factors or activities.
There are no identified Exacerbating factors, and the
Severity of the pain is comparable to labor pain.
Review By system
• GIT: No abdominal distension weight loss, dysphagia, constipation,
diarrhea, bleeding per rectum ,melena, jaundice. No fever
• Cardiopulmonary system: No cough, palpitation, chest pain, lower
limb oedema, dyspnea, syncope.
• Genitourinary system:, No polyuria , nocturia , urgency
hesitance , drippling ,poor stream ,poor evacuation, dysuria,
frequency, hematuria.
• Musculoskeletal system: No skin rash, itching, colour change, joint
pain, stiffness, muscle wasting.
• Nervous system: No headache, dizziness, muscle weakness, visual
disturbances, memory loss, UMNL ,LMNL.
Obstetric History
1. Current pregnancy
• LMP: Feb 2025
• Gestational Age: 36 weeks+ 6day.
• OBS U/S: yes
• Screening: yes: HIV ,HCV & HBV(-)
• ANC: NO , TT vaccinated in Hodan MCH
• Medical illness: no
• Mental health : good
• No history of radiation
2. Past Obstetric History
1ST Pregnancy
• Date of delivery : 2020
• Location of deliver : Traditional home.
• Duration of gestation : 39 weeks.
• Type of delivery : spontaneous vaginal delivery.
• Duration of labor : 10hrs.
• Maternal Complications : NO
• New-born Gender & Weight.
• Fetal & Neonatal Complications.
Continue……..
2nd Pregnancy
• Date of delivery : 2023.
• Location of deliver : Bandar hospital
• Duration of gestation : 38 weeks.
• Type of delivery : spontaneous vaginal delivery.
• Duration of labor : 14hrs.
• Maternal Complications : anemia
• New-born Gender & Weight. Male, weigt unknown
• Fetal & Neonatal Complications. No
Gynecological History
[Link] History
• Menarche: at the age of 13 years.
• Duration: 5 days
• Length : 28days apart.
• Regularity: regular
• Associated symptoms : mild abdominal cramps,
breast tenderness
• Red in color with no clots , NO painful and heavy of
menstruation.
Continue……..
1. Sexual history
• No history of postcoital bleeding
• No history of dyspareunia
• No history of STD
2. CONTRACEPTIVE HISTORY
• No contraceptive use
Past Medical History
• History of UTI
• No know history of chronic hypertension
• No know history of chronic Diabetes
• No history of blood transfusion
• No history of previous surgery
Drug and Allergic History
• Previous long-term Drugs: no
• Current drugs: See on management
• Not known food or drug allergy
Family History.
• similar condition for her mother
• No know for chronic disease
• No genetic diseases
Social History
• Occupation of father: driver
• Education level of couple: secondary level
• Composition of the family: 4
• House contain 2 rooms ,1 kitchen and 1 toilet ,
• having electrical source and water supply via
tap water.
• No domestic animals
• No Bad habit in the family
General Examination
Appearance: patient looks well, alert ,conscious.
Body build: on normal average
Color : There is pallor on conjunctive, no conjunctivitis ,
jaundice.
Decubitus: comfortable supine position
Bed clue: Right IV cannula and no Catheter.
Continue……..
No angular stomatitis, central cyanosis, good oral hygiene .
No ear discharge and pain. No nasal flaring, and discharge .
No raised jvp , lymph node enlargement, and sign of goiter.
Breast
• No lump , nipples are averted, no ulcers
• EXTREMITIES
• No swelling, no deformity , warm , no sweating
• BACK
• No deformity and abnormal hairs.
Vital Signs
On admission In Examination
• T: 36.7 °C • T: 36.9 °C
• RR:18 breaths/min • RR:18 breaths/min?
• PR: 104beats/min • PR: 103 beats/min
• BP:95/64 • BP: 98/64 mm Hg
Local Examination.
• Abdominal examination
• On inspection:
1. Abdominal contour asymmetry and distended ( due to pregnancy)
2. Moves with respiration, no scar, dilated veins, cautery marks and
visible pulsation
3. Skin of abdomen She has Linea nigra and striae gravidarum in here belly
and the
4. Umbilicus is everted.
5. Fetal movement present
Continue……..
• on palpation:
• Superficial palpation normal temp, no superficial tenderness ,
• Deep palpation no deep mass and organomegaly
• Palpation of pregnant uterus
1. uterus size
• fundal height 33 cm
• Fundal level : Between Umbilicus Xiphisternum
(
Leopold's maneuvers
Leopold's maneuvers
1. Fundal grip: Characterized By Soft , Irregular , Comprisable which
means the fundus is breech
a. Interpretation: fetus is Cephalic.
2. Lateral grip : maternal right side and small, irregular parts on the left.
a. Interpretation: The fetal back is on the maternal right.
3. 1st Pelvic grip ( 1 hand )hard, round, and well-flexed structure,
confirming the fetal head.
a. Interpretation: The fetal head is engaged in the pelvis, indicating
progression of labor.
4. 2nd pelvic grip ( 2 hand)
AUSCULTATION
• AUSCULTATION for fetal heart
• Fetal heart beat is present heard Mid-Way Between Umbilicus And
Anterior Superior Iliac Supine.
Pelvic Examination.
• Inspection.
1. diamond shaped hair disruption.
2. Vulva No swelling ,
3. no ulcer , pink in colour
4. Blood-tinged mucus.
• Bimanual Examination
• Cervix .
1. position anterior
2. soft
3. Dilated by 7cm
4. 80% effacement
• Fetal position and descent
• Cephalic
• Ischial spines +2
• Membrane status
Ruptured
• Pelvic out let
CBC INTERPRETATION
• RBC:3.7 (3.80_5.10
• RBC? • HGB: 9.6 (11.5_15.0)
• HGB? • HCT: 29.0 (35.0_45.0)
• HCT? • MCV: 83.0 (80_100)
• MCV?
MCH?
• MCH: 29.4 (27_34)
•
• RDW_CV? • MCHC : 35.4
• RWD_CV: 15.4 (11.5_14.5)
• INTERPRETATION: NORMOCYTIC
NORMOCH0ROMIC ANEMIA
Ultrasound
1. single
2. Cephalic
3. Alive fetal heart rate present
4. PLACENTA Posterior.
5. Normal amniotic fluid
6. GA 36 + 6DAYS
7. FL 7.7
8. Weight 2.9kg
NORMAL PREGNANCY
DIFFERNATIAL DIAGNOSIS
• True Labor ( active phase ).
• Normal labor criteria
• Spontaneous expulsion.
• 2. Of a single.
• 3. Mature fetus (37. completed weeks-42. weeks).
• 4. Presented by vertex.
• 5. Through the birth canal (vaginal delivery).
• 6. Within a reasonable time (more than 3, less than 18 hours).
• 7. Without complications to the mother.
• 8. Without complications to the fetus.
• False labor.
DIAGNOSIS
• Active phase labor
• Diagnosis criteria of true labor
• Dilatated cervix for 7 cm
• Ruptured membrane
• Blood-tinged mucus
• Cervical effacement ≥80%
• Criteria of admission.
• Active phase of labor
• Rupture of membrane and Any complication
MANAGMENT
• Admission ward 15
• Canulization
• Monitor vital signs every 30 minutes
• Monitoring FHR every 30 minutes
• monitoring progress of labor
• Buscupan inj
• Rl infusion 500ml
• Misoprostol 800mg tab.