Competency Appraisal – OB-GYNE

Case Scenario
Level 4
Post-partum
29-year-old G 2P1 was admitted in active labor at 40 weeks with 3 cm dilatation after
uncomplicated pregnancy. Patient’s labor progressed normally during the dilatation stage.
However, she had prolonged second stage which require oxytocin augmentation and ultimately
assisted low forcep delivery was done to deliver a 3800-gram neonate. Oxytocin 10 units was
given intramuscularly prior to placental delivery. Oxytocin 10 units incorporated to PNSS I L and
regulated at 125 cc/hr. Patient passed large clots 20 minutes after delivery. BP 120/80, pulse 90
bpm. Uterus soft and up to the umbilicus.
Teaching points: Consider
1) Risk factors for PPH
2) Amount of blood loss to consider PPH
3) Identify source of bleeding? How?
a. Atony vs. cervical/vaginal tear or uterine prolapsed
b. Placenta inspected/complete?
Patient received 1 ampoule of methergine and carboprost IV. Patient was typed and crossed.
Oxytocin infusion was opened wide. Bleeding does not stop. BP 90/60, pulse 130.
Teaching points: Consider
1) What lab studies will be done? Why?
2) What type of blood for transfusion will be given? What are the nursing responsibilities?
3) How should hypovolemic shock be managed?
4) To control bleeding what treatments must the nurse anticipate?

Guide questions:
1) What are the obstetrical problems in this case? Discuss each?
2) What test/exam may be done to support your answer in no. 1?
3) Present the pathophysiology of this case, utilizing a diagrammatic format.
4) Prepare a comprehensive nursing care plan that will address the priority problems of
the patient.