tetanus toxoid 2 Hct 40 Risk short stature

- ����� tetanus toxoid 2 ��� -Hct 40 %

Risk -short stature 141 cm.

Examination. - -PR 80/min. BP 120/80 -RR 20/min BT 37 c. HEENT not pale no jaundice -������� ���

Uterus: Height of fundus 3/4 > ���� Back of fetus left Presentation Ceph. Fetal heart sound 140/ R Estimated fetal wt 3400 gms. Extremities No edema.

Neurological exam intact reflex 1+ Pelvic examination Pelvis: Diagonal conjugate >13. 5 cms. Interspinous diameter >10. 5 cms. Ischial spines not prominent Sacral curve Good Subpubic angle >85

Cervix : Consistency Firm Effacement 50% Dilatation 1 FB. Membranes Intact

����� admit ����� ? ? How to manage? ? patient in latent phase

���� latent phase Uterine contraction -��� contraction ��� 1/2 -1 ��. Cervical dilatation - PV ���������� Active phase - Spontaneous rupture of

Date Contraction Time 14��Int Dur 10. 50 13. 00 13. 30 5’ 00” 40” mild 14. 00 4’ 20” 40” mild 14. 30 4’ 30” 45” mild Cervix Present part Eff Dil %50 1 FB 50% 1 FB Sta 0 1 - FHS Medicatio n Suture 150 Cephal 140 138 140.

Date Contraction Time 14�� Int Dur 15. 00 4’ 40” 45” mild 16. 00 4’ 40” 45” mod 17. 00 2’ 30” 40” mild 17. 30 4’ 20” 40” mild 18. 00 3’ 30” 45” mild Cervix Eff Present part Dil Sta FHS Medicati on Suture 150 140 152 138 152.

Date Contraction Time 14�� Int Dur 20. 00 4’ 40” 45” mod 21. 00 3’ 30” 45” mod Cervix Eff Present part Dil Sta FHS Medicati on Suture 150 80% 4 cm 0 ceph 140 hydration ���� active room 21. 30 4’ 20” 40” mild 18. 00 3’ 30” 45” mild 138 152.

Rt lat. wall convert sacrum Artificial rupture of membrane , hydration adequate

ARM. . hydration

Active Phase - ��� contraction ��� 15 - 30 ���� - ������ 2 ������� - Fetal heart sound - Blood pressure, pulse rate - Full bladder

Augmentation and Sedation hypo. uterine contraction

Augmentation ARM

Alert line Action line

Latent Phase 5 hrs 40 mins Active Phase -Protracted active phase of dilatation -station����� -1

! DYSTOCIA!

�������� Dystocia ��������. 1 Power 2. Passage 3. Passenger Physiologic support

����� Power - ����� drip syntocinon - uterine contraction �� ������ �� �Power ������ Passage / Passenger ������

CPD ( Cephalopelvic Dysproportion ) Mueller Hillis maneuver !Plan! Cesarean Delivery

New Born Sex Weigh Male Alive 3630 gm. Length 57 cm. Apgar Scores(1 min) 9 (5 min) 10 ����� F/E �����

Labor Onset of Labor 10. 00 First stage Full dilatation - Second stage Birth of Child 23. 00 Third stage 1 min. Birth of Placenta 23. 01 Duration of labor 13 hrs 1 min Date of Birth 2 �. �. 44 Station presenting part -1 Type of rupture artificial at 16. 40

Delivery Position ROA Operation C/S with F/E indication CPD Placenta Normal Weight 800 gm. Length 62 cm.

Post operative order for LT/CS 44 / 5 / 2 NPO ������ 12 hrs. record v/s q 15 min *4 q 30 min *2 q 1 hr until stable retained Foley’s catheter 5% D/N/2 1000 ml+ Synto 10 u 120 ml/hr *1 then 5% D/N/2 1000 ml *2 Medication Ampicillin Morphine Plasil

3/9/44 Orders for one day 5% D/N/2 1000 ml IV drop 120 cc/hr * ������ 4/9/44 Order for one day ����� liquid diet ��� IV ��� off ����� cath Order for continuation Paracetamol(500) 2 tap per oral ��� 4 -6 ��

- 5/4/44 Dressing wound Soft diet - 6/4/44 Regular diet - 7/4/44 Discharge �������