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A lаbоring pаtient is hаving cоntractiоns every 1 ½ - 2 minutes, lasting 60 to 90 seconds, and of strong intensity. The fetal head is visualized when the patient pushes involuntarily. A vaginal examination reveals a completely dilated (10 cm) and fully effaced (100%) cervix. What stage of labor is the patient in?
A 28-yeаr-оld femаle presented tо the emergency depаrtment with severe abdоminal pain symptoms and light vaginal bleeding. Nurses' notes 0100: Patient arrived unaccompanied to the emergency department complaining of vaginal bleeding and severe unilateral abdominal pain. Patient is complaining of headache, nausea, fatigue, breast tenderness, diarrhea, and urinary frequency. Patient has a history of irritable bowel syndrome. She reports last menstrual period was 7 weeks ago. Denies pregnancy and states that she has an intrauterine device for birth control. States severe abdominal pain and light vaginal bleeding began approximately three hours ago. Took ibuprofen, but the pain kept increasing. Patient is tearful. Small amount of vaginal bleeding noted on the patient's pad. 0115: Patient requesting pain medication for severe cramping. Vaginal bleeding remains light. Patient is diaphoretic and pale. Complains of feeling lightheaded. Head of the bed lowered. MD notified. 0145: IV started with 20-gauge catheter. Human Chorionic Gonadotropin and CBC labs sent. Pelvic exam performed by MD. Vaginal ultrasound preformed. Patient extremely uncomfortable. Vital signs Time 0100 0115 0145 Temp 99F - 37.2C Pulse 112 115 118 RR 24 24 26 B/P 98/64 94/62 90/58 Pulse Oximeter 96 on 21% 96 on 21% 94 on 21% Pain 10/10 10/10 10/10 Laboratory Report Lab Results Reference Range Hematocrit 30% Males: 42-52%; Females: 32-42% Hemoglobin 10g/dL Males: 13-18g/dL; Female: 11.55-14g/dL WBC 11,000 cells/mm³ 5-15,000 x 10³cells/mm³ Platelets 300,000/mm³ 135,000 to 350,000/mm³ Beta human chorionic gonadotropin 5,000 mlu/mL Non-pregnant women: less than 5 mlu/mL Diagnostic Reports Transvaginal ultrasound no products of conception in the uterus. Evidence of active bleeding in the peritoneal cavity Choose the one best answer for each category The condition the patient is most likely experiencing [1] Actions to take [2] Parameters to monitor [3]