SIGNS AND SYMPTOMS OF TRUE AND FALSE LABOR

Prof. K.Punithalakshmi

Principal

JIETCON

��Definition of Labor

• A coordinated effective sequence of involuntary uterine contractions that result in effacement and dilatation of the cervix; and voluntary bearing down efforts leading to the expulsion per vagina of products of conception.

• Typically, the diagnosis is reserved for :
• Uterine contractions which result in cervical dilatation and/or effacement.
• Bloody show (a small amount of blood with mucus discharge [i.e., mucus plug] from the cervix) may precede the onset of labor by as much as 72 hours.
• Fetal membranes rupture with gushing of amniotic fluid prior to the onset of labor.
• Cervical effacement > 80% or dilatation >3cm)
• Contraction must be present always to consider labor

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1) Show should be disregarded if there is a membrane rupture or digital PV exam done with in 48 hours prior to show.

2) Rupture of the membranes without presence of painful uterine contractions is PROM,

3) Cervical change without presence of painful uterine contractions is either cervical incompetence, or a normal finding in most multiparous woman.

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Physiologic preparations of labor

• Lightening - the settling of the fetal head into the brim of the pelvis.
• Braxton Hicks contractions - During the last 4–8 weeks of pregnancy irregular, generally painless uterine contractions occur with slowly increasing frequency. These contractions, may occur with greater intensity during the last weeks of pregnancy
• Bloody show - passage of a small amount of blood-tinged mucus from vagina, as the cervix begins to soften, efface, and dilate.

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Admission criteria for labor

1. All women with diagnosis of labor ( latent and active) with ruptured membranes, or

2. All women with diagnosis of labor ( latent and active) with known risk factor, or

3. All women with diagnosis of active labor (i.e. cervix dilation is ≥ 4 cms with complete or 100% effacement) with/without presence of rupture of membranes or risk factor.

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Factors for Successful Labor

1. The passage:- maternal bony pelvis, & soft tissues (uterus, cervix, pelvic floor, perineum)
2. The Passenger:- Fetus, placenta & membranes.
3. The Powers:- uterine contraction, maternal bearing effort, pelvic floor resistance.

�Premonitory signs of labor: weeks before real labor occurs “False Labor”�

• Lightening: Fetus settles into pelvic cavity.
• Braxton-Hicks: Irregular intermittent contractions; “false labor”; DO NOT initiate true labor.
• Cervical changes: cervix effaces [thins] & dilates slightly

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• Baby's head in pelvis pushes against cervix causing relaxation and effacement.
• Burst of Energy: Nesting instinct; cleans house, sets up nursery. ↑ epinephrine resulting from ↓ progesterone
• Cervix in posterior position.

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Signs True Labor: closer to time of delivery�

• Uterine Contractions: regular & frequent compared to Braxton-Hicks. Stronger with time.
• Bloody Show: pink tinged secretions d/t softening cervix.(mucous plug)
• Rupture of Membranes: (ROM) Labor in 24 hrs. Multipara sooner. Big gush or slow trickle.
• Clear/odorless. Green/brown, danger sign
• Meconium aspiration > distress/infection.
• Immediate medical attention.

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PROM or prolonged ROM – intrauterine infection [pathogens reach fetus]

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True labor vs. False labor

Summary

Diagnosis of labor made on the presence of :

• At least two contraction per 20 minutes lasting 20 seconds, and
• Cervical dilatation of 3-4 cm or more
• Cervical effacement of 80% or more
• Show
• Rupture of membranes

At least two criterias needed to make the diagnosis.

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