NORMAL LABOR AND DELIVERY

Definition
Normal Labor and delivery is phsyologic processing during which the fetus, membrane,
umbilical cord, and placenta removed from the uterus with gestation 36 to 42 weeks.

Preparing
PPE (Personal Protective Equipments) Medical Tools

- Mask - Thermometer
- Gloves - Spigmomanometer
- Apron - Stetoscope
- Boots - Partus set
- Hacting set
- Under pad
- Section
- Dopler

Symptoms
Stages of labor :
1. First stage : Dilation and Effecment of the cervix
- Early or latent phase : cervix dilates from 0 to 3 or 4 cm
- Active phase : cervix dilates from 4 to 7 cm
- Transition phase : cervix dilates from 8 to 10 cm

For Nulliparous women 14 hours

Multiparous women 8 hours
2. Second stage : Pushing and Birth (Delivery Prosessing)
- Complete dilatation followed by rupture of membrane
- Internal rotation then external rotation
- Tracking along the body from the soullder to the leg
- Clamping and cutting umbilical cord
- Cleansing the baby
- Checking APGAR score

For Nulliparous women 2 or 3 hours

Multiparous women 1 or 2 hours

3. Third stage : Delivery of the plasenta

- Giving oxitocin for the uterus contraction
- Delivery of the placenta
- Chacking placenta, bleeding, and rupture < 30 minuts
For baby :
. giving Vit.K n oxitetracilin
. checking vital signs, baby weight, n baby large
- Breastfeeding
- Giving join treatmen both mother and baby.

Potentials : For mother : Rupture, Rest Placenta

For baby: sionosis, aspiksia
MOST CASE:
PLACENTA PREVIA

Definition
Placenta Previa is placentation or placenta growing in an abnormal position sach as low,
marginalis, parsialis, totalis

Symptoms
Patient coming with …. little bleeding light red
1. Pale
2. Fatigue
3. Weaknees
4. Low blood pressure

Treatment
1. Chacking vital signs
2. Consalting the doctor
3. Giving medicine by invusion (IV)
4. posible cesarian for marginalis, parsialis and totalis

Education
1. Giving the patients bed rest
2. Giving psycological support
3. Giving good nutrients, such as…
MOST CASE:
SOLUSIO PLACENTA

Definition
Solusio placenta is loosing placenta partially or totally from the uterus before term

Symptoms
Patient coming with ….. lower back pain and abdominal
1. Past contraction
2. vagina bleeding
3. lees then 10 time fetal movemen

Treatment
1. Checkin vital signs
2. Consulting the doctor

Education
MOST CASE:
RETENTIO PLACENTA

Definition
Retentio Placenta is placenta not removed after 30 minuts after baby delivery

Shympton
1. Mother exhausted , shock (sangat lelah terkuras)
2. Fundus uteri, mushy

Treatment
1. Checking vital signs
2. Consulting the doctor
3. Giving medecine such as, RL n Oxitocin 500 ml by Infusion for 15 minutes (2 times)
4. Doing manual Placenta

Education
1. No Pushing
2. Giving psychological support and nutrition
MOST CASE:
REST PLACENTA

Definition
Rest Placenta is placenta rested or not removed and the membran left by the uterus causing
bleeding.

Symptom
1. Post partum bleeding
2. Incomplete placenta
3. Weakness
4. Low blood preassure
5. High pulse rate
6. Shock
7. Dizzy

Treatment
1. Cecking vital signs n bleeding
2. Consulting the docter
3. Giving antibiotic by infution with adequate
4. Vagina exploration
5. Curretagge

Education
1. Giving psicological support
2. Having Bedrest
MOST CASE:
ATONIA UTERI

Definition
Atonia Uteri is uterus weak or no contraction during postpartum

Shypmtom
1. Uterus with low or no contraction
2. Bleeding

Treatment
1. Checking Vital Signs
2. Consulting the doctor
3. Giving Ergometry by IM for stop bleeding
RL 500 cc with oxi 20 unit by infution (2 minuts)
4. Internal Bemanual Contraction (KBE)

Education
1. Taking nutrition and bedrest
MOST CASE:
MASTITIS

Definition
Mastitis is imflamatid by mammary gland because of nipple disappear (Dis’eppier) or
blocking by the way-out for the breast milk. Why? Mammay gland always produce (Projus)
breast milk during lactation periode

Symptoms
Patient coming with pain around breast because inflamated
1. Redness
2. Swelling

Treatment
1. Checking vital signs
2. Consulting the doctor
3. Giving antibiotic
4. Compressing the breast with warm water
5. Sucking the breast milk

Education
1. Continueing breastfeeding
2. Giving breast care treatment
3. Giving nutrition
MOST CASE:
ANEMIA

Definition
Anemia is mother condition with hemoglobin less than 11 gr % in treimester 1 & III and less
than 10,5 gr% in trimester II

Symptom
Patient coming with fatigue and weakness
1. Pale
2. Fatigue
3. Weakness
4. Dezzy
5. Lazy

Classification:
- Hb 11 gr% : No Anemia
- Hb 9-10 gr% : Low Anemia
- Hb 7 – 8 gr%: Mild Anemia
- Hb < 7 gr% : Severe Anemia

Treatment
1. Checking vital sings
2. Consulting the doctor
3. Giving medicine such as Fe tablet

Potential
1. Preterm labor
2. Abortion
3. Spooting
4. Intra uterine fetal dead
5. Abdormliti genatali

Education
1. Having bedrest
2. Taking nutrient
3. Giving pshycology support
MOST CASE:
PIH (Pragnancy induced Hypertentio)

Definition
BP more than 140 Sistolic and 90 diastolik (140/90 mmHg) after 20 weeks gestation without
proteine in urine.

Symptom
Patient coming with blurring vision (penglihatan kabur)
1. Headache
2. Pain by the abdominal
3. Nuesea and vomitting
4. Decresed trombosit in the blood
5. Impaired liver funcion
6. Brethless

Treatment
1. Cecking vital signs
2. Consulting the doctor
3. Giving antibiotik (Aspirin low dosis 60x80 mg)

Potensial
1. Preeclamsia and eclamsia

Education
1. Reducing salty food
2. Drinking water 50%/mother waight
MOST CASE:
PREECLAMSIA

Definition
Preeclamsia is placentation obstructed by less oxygen to the fetus causing hypertenton,
protein urine +, n Udema

Symptom
Patien coming with weakness
- Low (mild) Preeclamsia
1. BP 140/90 mmHg
2. Edema – increace 1 kg body weight during 1 week
3. Proteinurin 0,3 gr/liter – Kualitatif +1 or +2
- Severe Preeclamsai
1. BP 160/ 110 mmHg
2. Proteinurine 5 gr/liter – kualitatif +3
3. Oliguria less than 500 cc/24 hours
4. Disfuncion of visus
5. Pain by the epigastrum
6. Lung edema and sianosis

Treatment
1. Checking vital signs
2. Consalting the doctor
3. Taking MgSo4 = 4 gram by IV 40% during 5 minut (3 day) (repeate 4 gr IV)

When no getting recover then giving induktion or termination

Potential
1. Eclamsia

Education
1. Taking bedrest
MOST CASE
ECLAMSIA

Definition
Preeclamsia followed by comvulsion

Symptom
Patient coming with comvulsion

Treatment
1. Taking patient directly to operating room

Education
MOST CASE:
PREMATUR RUPTURE OF MEMBRAN

Definition
Prematur rupture of membran is membrane ruptur before term

Symptom
Patient coming with rupture of membrane
1. Lower Back pain
2. Fever
3. Heavy or foul-smelling vaginal discharge,
4. Abdominal pain
5. Fetal tachycardia
6. Particularly if out of proportion to maternal temperature

Potential
1. Chorioamnionitis
2. Aspiksia

Treatment
Preterm
1. Infution treatment, with trendelenberg potition
2. Giving antibiotic (ampisilin 4x500 mg or eritromisin) and metronidazol 2 x 500 mg
during 7 day.
3. Giving induction when gestation 32 to 37 weeks
4. Giving steroid for fetal lung matiriti when gestation 32 to 34 weeks
5. Checking infaction shymptom
Aterm
1. Giving oxitocine for gestation or misoprostol 50 mg by intravaginal every 6 hours
maximum 4 x, more than 37 weeks, when fail then secio secarian
2. Giving antibiotic with hight dose, when infaction shymptom coming then terminating.

Education
1. Having bedrest and nutrition
MOST CASE:
CYANOSIS

Definition
Baby with skin colour and mucosa membrane; blueish or pale indicating low oxigen in
blood.

Symptom
1. Blue or pale skin
2. Breathlessness
3. Weakness in crying

Treatment
1. Checking vital signs for the baby
2. Consalting the doctor
3. Giving Incubator treatment
4. Sucking

Potential
1. Hipotermi

Education
MOST CASE:
HIPOTERMI

Definition
The Decreasing of baby themperarute less than 30oC (celcius degree)
Baby temperature lost by Evaporation (Amnion), conduction (padding), radiation
(environment), konvection (room temperature)

Shymptom
1. Less aktif
2. Weakness in crying, weak in sucking breast milk
3. Baby face, light red
4. Baby looks sleepy, weakness, shiver
5. Blue at extremities

Treatment
1. Checking Vital Signs baby
2. Consulting the doctor
3. Giving Incubator treatment

Education