NORMAL

DELIVERY
Desyani Aviciena Adiyuwono Putri
12100115058
Supervisor :
dr. Mutawakkil J. Pranansa Sp.OG
I N T R O D U C T I ON
 Normal Labor is delivery of the fetus from the
uterus and expulsion of the placenta  Mother and
Fetus is Normal

RISKESDAS 43,2% of Childbirth

2010 were in Home

Wrong
Management

Maternal, Fetal Morbidity and Mortality

CASE
 PATIENT
IDENTITY

Name Mrs. Sn Mr. Snd

Date of Birth/ 23 years old 24 years old
Age
Nationality Indonesian Indonesia
Address Perumahan Baros Perumahan Baros
Graduate Senior High school Senior high School
from
Marital Married Married
Status
Occupation Minimarket employee Minimarket employee
Religion Islam Islam
Date of December 4th 2015,
admission 05.03 AM
 HISTORY
TAKING

Comes to obstetric emergency, complaining of regular

uterine contraction 6 hours before admission

 Bloody Show
 Vaginal fluid leakage (-)
 Fetal movement still be
felt
Chronic Illness Disease & Family Illness : denied

Menstruation History
• First day of last menstrual period : February 20th 2015
• Estimated day of labor : November 27th 2015
• Menstrual cycles : regularly, duration 5 days

Contraception History
• She never using any contraception

Marriage History
• First marriage

Obstetric Status
Primipara

Antenatal Care
• 4-5 times to obstetrician
 PHYSICAL
EXAmiNATION
• General conditions : Mild
• Consciousness : Composmentis
• Blood Pressure : 120/80 mmHg
• Pulse Rate : 86 bpm
• Respiratory rate : 19 bpm
• Temperature : 36,1 0C
• Weight : 69kg
• Height : 153 cm
HEAD
- Conjuntiva anemis (-/-), Sclera icteric (-/-)
- Oral mucous : Normal
THORAX
- Cor and Pulmo : within normal limit
EXTREMITIES
edema (-) , Physiologis Reflects (+)
 OBSTETRIC
EXAMINATION
EXTERNAL EXAMINATION
INSPECTION :
Convex
PALPATION
> (Leopold Examination)
Leopold I: - FH : 34 cm ->EFW : 3700GR
- round, soft, : buttock
• Leopold II : small part (right), hard and longitudinal
(left) : single, Longitudinal lie
• Leopold III : round, hard, movable : head
• Leopold IV : convergent , 5/5
HIS : HIS : (+), frequency 3x 10’ duration 20s
AUSCULTATION
• FHR : 147 bpm, reguler
INTERNAL EXAMINATION
Vulva/ vagina : not found any abnomalities

Portio : Thick, soft

Cervical dilation : 2-3 cm

Fetal membrane :+

Fetal presentation : Vertex Presentation

Fetal Position: Transverse Sagital Suture

Descent : Station -3, Hodge I

Pelvic Examination : Normal

 LAB
EXAMINATION

4th december 2015

Hemoglobin : 10,4 gr/dl

Hematokrit : 33 %
Leukosit : 9900/μL
Trombosit : 187.000 / μL
 ADMISSION
DIAGNOSIS

G1P0A0, 23 years old, Parturien aterm (40 weeks)

First stage of Labor with Laten period

Intra Uterine Fetal Life, single, with vertex

Presentation
Management Planning

VAGINAL BIRTH
Waktu TD N R S DJJ HIS Pemeriksaan Dalam
mmH x/m x/m 0C x/m
g
05.05 120/8 88 20 36,5
0
147 2x / 10’ ,
reg
Durasi : 20”
v/v tidak ada kelainan, portio tebal, lunak,
pembukaan 2 cm, KET +, St -3

11.00 120/7 79 18 37
0
144 3x / 10’ ,
reg
Durasi : 20”

v/v tidak ada kelainan, portio tipis, lunak,

pembukaan 2-3cm, KET +, Preskep St -3
13.35 140/ 80 20 36,5
90
140 3x / 10’, reg
Durasi : 25”

v/v tidak ada kelainan, portio tipis,

lunak, pembukaan 3-4 cm, KET +,
Preskep St -3

19.00 130/ 83 21 36,4

80
148 3x / 10’, reg
Durasi 30”

v/v tidak ada kelainan, portio tipis,

lunak, pembukaan 3-4 cm, KET +,
Preskep St -3
01.00 120/ 88 20 36,3
70
144 4x/10’, reg
Durasi : 40”

v/v tidak ada kelainan, portio tipis,

lunak, pembukaan 4 cm, KET +,
Preskep St 0

05.00 110/ 84 21 36
70
144 4x/10’, reg
Durasi : 40”

pembukaan 8 cm, KET +, Preskep St

+1
Diagnosa : Impartu kala I dengan inersia Uteri
R/ : Amniotomi -> cairan putih keruh
Pantau Kemajuan persalinan (observasi)

Ibu ingin mengejan

06.00 110/ 84 22 36,5
70
142
5x/10’, reg pembukaan lengkap, KET -, LBK, St
Durasi : 50” +3

Diagnosa : Impartu kala II

R/ : Pimpin Meneran

06.55 120/ 84 20 36 Bayi Lahir Spontan Pervaginam,

80 perempuan, BB: 3360 gr, panjang : 49
cm, AS : 1’ = 8, 5’=10

Diagnosa : Impartu kala III

R/ Manajemen Aktif Kala 3

06. 57 120/ 84 20 36 Lahir plasenta, lengkap dengan

80 selaput
Diagnosa : Impartu Kala IV
R/ Penjahitan Luka episiotomi,
Pengawasan Selama 1 jam : TTV, Kontraksi Uterus, Perdarahan Pervaginam,
produksi Urin
 PROBLEM

How to manage the First stage in this case ?

How to manage the Second stage in this case ?

How to manage the Third stage in this case ?

How to manage the Fourth stage in this case ?

How to manage the Puerperial stage in this case ?

How to manage the First stage in
this case?
Determine, when the labor is started?
1.Mother feel Regular contraction of
uterus
2.Exam: Contraction of uterus f: 2x on
10’
3.Portio : Effacement and dilatation of
cervix
In this Case
Regular uterus contraction since 6
hours before admission
On Examination:
*Contraction of uterus f: 2-3x on 10’
> Effacement and Dilatation of cervix is 2
cm

 Parturien aterm First Stage of Labor

with Laten Period
R/ Active Management of Labor
 Management of Normal Delivery

Partograph
Evaluate :
1. Labor Progress:
 HIS  evaluate every 30 minutes
 Cervix Dilatation  evaluate every 4
hours/<
 Descent  evaluate every 4 hours/<
2. Evaluate the Fetus:
 FHR  30 minutes
 Amnion  < 4 hours
 Moulding  < 4 hours

3. Evaluate Mother’s Condition

 Mother’s complain
 Vital sign  < 4 hours
 Urine Production  everytime
4. Others Management

- Drink mineral water, use lip balm, hidration

with RL
- Walk a bit during first stage
- Give analgetic if the laboring woman want to
use
- woman should be allowed to assume the
position she finds most comfortable
In This Case :
• Onset of Labor is started 6 hours before
admission
• Evaluated the progress of normal labor with
partograph
• Laboring woman drink some waters and eat
some foods, and she is suggested to lateral
recumbency
• Started with well progress, but in a moment
 Inersia uteri
R/ Amniotomy
How to manage of the Second
stage in this case?
 Signs of the second stage :
1.Have a feel to bear when uterus
contraction
2.Pressure on anus
3.Protution the perineum
4.Opening of vulva
5.Increase secret with blood
6.Dilatation cervix complete
7.Head of baby at introitus vagina
Factors which is important in
second stage of Labor

HIS and the power of bearing

In This Case :
• After performed amniotomy, the
mothers has a feel to bear when the
contraction of uterine
• Dilatation of cervix is complete
• Pressure on anus

Because of that, we lead a laboring

woman to bear when the uterus
contraction 
Cardinal Movement
How to manage of the Third
stage in this patient?
 Signs of Placental Separation :
1.The uterus becomes globular and as a rule,
firmer
2.There is often a sudden gush of blood
3.The uterus rises in the abdomen because the
placenta, having separated, passes down into the
lower uterine segment and vagina. Here, its bulk
pushes the uterus upward
4.The umbilical cord protrudes farther out of the
vagina, indicating that the placenta has
descended.
Active Management the third stage
of labor :
1. Intramuscular injection of
Uterotonica
2. Clammping and Cutting the
umbilical cord
3. Streching the umbilical cord gently
 Perform after delivery of fetus
How to manage the Fourth stage
in this case ?
1. Massage the uterine to stimulate the
contraction of uterine
2. Evaluate fundal height
3. Evaluate the bleeding
4. Evaluate mother’s condition 2 hours post
partum
5. Evaluate blood pressure, pulse rate,
temperature, fubdal height, urinary bladder,
bleeding every 15 minutes during 1 hours,
every 30 minutes 1 hours post partum
6. Repairing Laceration of the perineum
 How the management of the
Puerperial stage in this patient?
Puerperial stage start from 1 hours after
delivery placenta until 6 weeks after that

Evaluate :
-Vital sign
-Fundal height
-Breast milk
-Lochia
- Perineum
- sign of puerperial infection
- sugesstion to use contraception
In this case, the patient is hospitalized 1 day, she is
suggested to using contraception. There are no
signs of puerperial infection
 C ON C L U S I O N

Female 23 Years Old, P1A0 spontaneous

delivery, performed normal delivery
management.
THANKYO
U