Saint Michael’s College of Laguna

School of Nursing and Midwifery

Old National Highway, City of Biñan Laguna

A Case
Study of
Cesarean
Delivery
(Breech
Presentation
)
Biñan Doctors Hospital
(July 19, 20, 21 – June 26,27,28, 2010)
Submitted by: Zarian Evanuel G. Woo
BSN 4B
Submitted to: Ma’am Nora Ocharon
Clinical Instructor
PATIENT’S PROFILE

Name: Patient RMJ

Age: 28 years old

Gender: Female

Civil Status: Married

Nationality: Filipino

Address: 9179 J.M. Loyola Street Maduya Carmona Cavite

Religion: Roman Catholic

Date of Birth: August 02, 1981

Attending Physician: Dr. Brilliantes

Date of Admission: July 16, 2010 (5:30am)

Final Diagnosis: PUFT Cephalic in Labor with alive Baby Boy

G2P2 (2002) Previous CS on Breech
Presentation

Patients’ History: chief complain: For CS

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 vulva—which 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 mother’s abdomen and uterus to deliver one or more babies.
It is usually performed when a vaginal delivery would put the baby’s or
mother’s 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 fetus’s
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

Actual Normal Nursing

Procedure / Date Implications
Findings Findings Responsibilities
1. CBC Pre:
 Check Doctor’s
Hemoglobin 116 120 – 140 g/dL Decrease Order.
- Indicates  Inform client and
occurrence of explain the
0.30 anemia procedure.
Hematocrit 0.35 Increase  No need for NPO.
- Indicates
5 - 10 hypercoagulation Intra:
WBC 8.0 0.36 - 0.66 Normal  Perform blood
Segmenters 0.60 0.22 - 0.40 Normal extraction
Lymphocytes 0.14 Decrease (venipuncture
- Indicates high technique) using
risk for acquiring aseptic technique.
infection  Put extracted
Eosinophils 0.02 0.01 - 0.04 Normal blood in
Stab Cells 0.04 0.02 - 0.05 Normal ethyldiamino-
Platelets 320 150 – 400x9/L Normal tetracetate (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.

URINE ANALYSIS
Microscopic Exam Chemical Exam

Color: Yellow Albumin: Negative

Transparency: Hazel Sugar: Negative

pH: 6.0 (7.35 – 7.45)

Specific Gravity: 1.010 (1.010 – 1.025)

Epithelial Cells: Moderate