CPC TOPIC

NORMAL LABOR
PRESENTED BY ROLL NO.
94 TO 98
 HISTORY
• Isma Ali 24 years old w/o Ali Subhani who is tailor by
profession resident of Islam ghar is married for 3 years .
• She was admitted through OPD on 17th of march 2025 .
• She was G2PO+1 .
• Her last LMP was 10 June 2024 and expected date of
delivery was 17 march 2025 and gestational age 40
weeks.
 CHIEF COMPLAINT

• Admitted via OPD for induction of labor .

 HOPI

She presented in morning of 17 march 2025 with full term pregnancy

with no labor pains.
 She was admitted for induction of labor via medicine .
 1st induction was done on 17th march at night and 2nd induction was
done on 18th march
1ST TRIMESTER

• Pregnancy was unplanned , spontaneous and confirmed by urine test in the

hospital.
• She took folic acid supplements during this period .
• She had no complaints of nausea ,vomiting and Headache .
• No history of any infection bleeding and discharge .
• Her dating scan and vaccination were also done .
2ND TRIMESTER
• She felt quickening at 5th month and anamoly scan was done which was
normal and had no deformity .
• There was no history of hypertension and polyphagia and polyurea .
• She also took iron and calcium supplements.
3RD TRIMESTER

• She has no history of hypertension cough fever headache or

discharge.
• Growth scan was done .
 OBS HISTORY
• She is G2PO+1
• She had no previous alive issues .
• she has history of miscarriage at 2 and a half month and that was
spontaneous .
• gynecological history :
• She had her menarche at the age of 16 .
• Cycle was regular of 3 to 5 days and used 2 sanitary pads per day .
• She had no history of Dysmanorrhea, intramenstrual bleeding and
post coital bleeding.
• No contraceptives were used and no pap smear was done..
FAMILY HISTORY
• No history of diabetes , hypertension and twin pregnancy . Her
husband is deaf and dumb and this abnormality runs in their family
.
PAST MEDICAL/SURGICAL HISTORY

• No significant past medical or surgical history .

 ALLERGIC HISTORY
• She had no allergy to any drug.
 SOCIOECONOMIC HISTORY
• Socioeconomic status was satisfactory .
• General physical
EXAMINATION
examination :
• Isma Ali 24 years old lady lying comfortably on bed has normal complexion
normal weight and height well oriented in place person and time .
• She has no signs of anemia clubbing and jaundice .
• On palpation there were no swollen lymph nodes .
• Examination of thyroid gland and breast.
• On abdominal examination
• linea nigra was observed no stria gravidarum were seen .
• Fetus lies longitudinally with cephalic presentation .
• Fundal height recorded was 37 cm .
• palpable head : 2/5
• 1/10 contractions with duration of 10 sec that lasting for 24 hours
 VITALS
pulse : 84 per min
respiratory rate : 20 per min
BP : 110 by 80
temperature : 98F
• on CTG fetal heart rate was between 120 to 148
• P/V examination
• Os : 1cm
• Cervix soft central 2.5 cm
• Vertix : -3
Membranes : intact bulging
• Pelvis : adequate
 1. *False Labor (Braxton Hicks Contractions)*:
DIFFERENTIAL
Irregular, mild contractions that don’t lead to
DIAGNOSIS
cervical dilation.
• 2. *Preterm Labor*:
• Labor that occurs before 37 weeks of
gestation.
• 3. *Prolonged Labor*:
• Labor that lasts longer than 18-24 hours.
• 4. Gastrointestinal issues:
• Appendicitis
• Gastroenteritis
FINAL DIAGNOSIS
Pain was due to uterine contractions for a normal labor
INVESTIGATIONS
1. Laboratory tests : CBC
CTG
FOETAL USG
BLOOD GROUP : RH FACTOR

• O positive
• Urine R/E
• Dating scan :

• Anomaly scan :
 MANAGEMENT

• She was admitted in ward

• CBC was done
• CTG stat was done
• Fetal heart rate was examined.
• BP, pulse temperature and respiratory rate
were examined.
• Blood was arranged and induction was
done after reactive CTG with written
consent.
After 20 minutes of induction contractions started.
After 10 cm of dilation of cervix 2nd stage started and patient was
shifted to delivery table.
She delivered a baby girl in about an hour
In 3rd stage of labor placenta was delivered completely.
Baby was handed over to the mother and she was checked for any tear.
She was advised for post natal follow up
 TREATMENT PLAN

• Antibiotics : IV Augmentin
PROCEDURE AND SURGERIES

• Episiotomy was done.

 FOLLOW UP CARE
• Proper instructions were given
• Patient was advised for sitz baths
• Medicines were given
1. Augmentin
2. Flagyl
3. Iron and calcium supplements
4. Polyfax gel
• Dietry care was advised
• Follow up in OPD was advised after 10 days
NORMAL LABOR
STAGES OF LABOR
First stage of Labor:-
Begins with regular uterine contractions and
ends with complete cervical dilation at 10cm.
•Consists of 2 phases:
1.Latent phase:
The latent phase begins with mild, irregular
uterine contractions that soften and shorten the
cervix.
2.Active phase:
• The active phase usually begins at about 3-
4cm of cervical dilation and is characterized
by rapid cervical dilation and descent of fetus.
• Second stage of Labor:-
• •Begins with complete cervical
dilatation and ends with the delivery of
fetus.
Third stage of Labor:-
• It includes delivery of placenta and
fetal membranes.
• Normally delivery of placenta takes less
than 10 minutes but third stage may
last as long as 30 minutes.
• Expectant management involves
spontaneous delivery of placenta.
• Active management often involves
prophylactic administration of oxytocin
or other uterotonics (prostaglandins or
ergot alkaloids, cord clamping/cutting
and controlled traction of umbilical
cord.
STEPS OF MECHANISM OF LABOR
“7 cardinal movements”
1.Engagement
2.Descent
3.Flexion
4.Internal rotation
5.Extension
6.External rotation
• 7.Expulsion
• 1.Engagement:
• The widest part of the fetal head (usually the occiput) enters the pelvic inlet.
• 2.Descent:
• The fetus moves downwards through the birth canal.
• 3.Flexion:
• As the head descends, it flexes, bringing the chin closer to the chest, which helps the head pass through
the pelvis.

• 4.Internal Rotation:
• The fetal head rotates to align with the pelvic outlet, allowing the widest part of the head to pass
through the birth canal.
• 5.Extension:
• As the head emerges from the birth canal, it extends, allowing the occiput to pass under the
pubic symphysis.

• 6.External Rotation:
• After the head is delivered, it rotates back to the position it was in when it engaged, allowing
the shoulders to pass through the pelvis.

• 7.Expulsion:
• Finally, the shoulders and the rest of the baby’s body are delivered
STEPS OF MECHANISM OF LABOR
EVALUATION OF PROGRESS IN LABOUR
ROLE OF
OXYTOCIN
IN LABOR
1.Oxytocin:
•It is known as hormone of love because it is involved with
lovemaking and fertility.
•Oxytocin plays a role in producing uterine contractions during labor
and birth and release of milk in breastfeeding.
•Receptor cells that allow your body to respond to oxytocin increase
gradually in pregnancy and then increase a lot during labor. Oxytocin
stimulates powerful contractions that help to thin and open (dilate)
the cervix, move the baby down and out of the birth canal, push out
the placenta, and limit bleeding at the site of the placenta. During
labor and birth, the pressure of the baby against your cervix, and
then against tissues in the pelvic floor, stimulates oxytocin and
contractions. So does a breastfeeding newborn.
• 2.Endorphins:
• It is a calming and pain-relieving hormone
• High endorphin levels during labor and birth can produce an
altered state of consciousness that can help you deal with the
process of giving birth, even if it is long and challenging.
• High endorphin levels can make you feel alert, attentive and even
euphoric (very happy) after birth, as you begin to get to know and
care for your baby. In this early postpartum period, endorphins are
believed to play a role in strengthening the mother-infant
relationship.
• A drop in endorphin levels at this time may contribute to the
“blues,” or postpartum depression, that many women experience
for a brief time after birth.
 SIGNS AND SYMPTOMS

• Periodic abdominal pain that is on and off

• Blood spotting
• Backpain
• Water breaking
• Urge to urinate
 EXAMINATION
• Palpation of head
• Palpation of uterine contractions
• Examination of fetal heart
• Pervaginal examination
• Examination of cervix, vertex and membranes
• Examination of pelvis
• Abdomen examination
• fetal position, head engagement, fetofundal height
• gestational age
• look for stria gravidarum and linea nigra
• Thyroid and breast examination
INVESTIGATION

• CBC
• Blood grouping
• BSR
 MANAGEMENT AND
TREATMENT OPTIONS

Admit the patient

Tests should be performed
Performance of CTG stat
Measurement of
pulse ,BP ,temperature ,respiratory rate and
fetal heart rate
Arrange blood
Induction of Antibiotics
Look for treatment options if normal then look
for spontaneous contractions
 PROGNOSIS
For a normal patient, without any underlying
medical conditions or complications, the
expected outcomes of deliveries
Outcomes
1. *Vaginal delivery*: A successful vaginal
delivery is the most likely outcome.
2. *Healthy baby*: A healthy baby with a
normal birth weight and Apgar score.
3. *Minimal complications*: Minimal
complications during delivery, such as tearing or
episiotomy.
Potential Complications
1. *Prolonged labor*: Labor lasting >18-24 hours.
2. *Fetal distress*: Abnormal fetal heart rate or other signs of fetal compromise.
3. *Maternal hemorrhage*: Excessive bleeding during or after delivery.
4. *Uterine rupture*: Life-threatening condition requiring emergency
intervention.
• 5. *Infections*: Maternal or fetal infections, such as chorioamnionitis.