Differentiating True from False Labor

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Pregnant women who are approaching near their expected date of delivery experience signs of labor. However, these women are not sure if what they are experiencing is either real or false labor. For every woman, every pregnancy is different. But in every pregnancy the same definitive signs of labor will be experienced by women. To figure out if the body is just practicing and preparing for the delivery or actual labor is occurring, pregnant women should be able to classify false from true labor.

Labor is a physiologic process during which the products of conception are expelled outside of the uterus. Regular contractions cause progressive dilatation of the cervix and sufficient muscular force to allow the baby to be pushed to the outside. Labor is a time of change, both an ending and a beginning for a woman, a fetus and a family.

A false labor also termed as prodromal labor is common because the exact time of the labor’s onset is rarely known and usually is gradual. This type of labor often causes women to rush to the birth center, thinking that labor has started. Several characteristics distinguish true labor from labor: contractions, discomfort and cervical change. The BEST distinction is that contractions of true labor cause a progressive change in the cervix, thus, in false labor there is no dilatation of cervix.

Signs of true labor involve uterine and cervical changes. The more a woman knows about the true labor signs, the better. Because it is only in this way that she can better recognize them once she is experiencing contractions. Knowing about the difference between true and false labor is helpful to prevent preterm birth and for the woman to feel secure knowing what is happening during the labor.

Contractions:

True Labor

• Begin irregular but become regular and predictable
• Contractions last between 4 to 6 minutes apart and may last up to 60 seconds or more
• Have a consistent pattern of increasing frequency, duration and intensity
• Tends to increase with walking
• Vaginal pressure and back pain accompanies contractions
• Begin in lower back and gradually sweeps around to lower abdomen
• Contractions accompanied by bloody show or mucous plug

False Labor

• Begin and remain irregular
• Do not increase in frequency, duration and intensity
• Weak contractions
• Interval between contractions don't occur shorter and remains the same all throughout
• Often disappear with ambulation, sleep, lying down or drinking fluid
• Felt first abdominally and remained confined to the abdomen and groin

Discomfort:

True Labor

• May persist as back pain in some women
• Often resembles menstrual cramps during early labor

False Labor

• Discomfort confined at the abdomen and groin only

Cervix:

True Labor

• Includes progressive effacement and dilatation (most important characteristic)

False Labor

• No cervical effacement and dilatation noted

Preschool Period

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Overview

The preschool period includes ages 3 to 5 years old children. During this time, physical growth is considerably slow and personality and cognitive growth is substantial. The psychosocial development of preschoolers is initiative vs. guilt. As preschool children encounter a widening social world, they are challenged more than when they were infants. Active, purposeful behavior is needed to cope with these challenges. Children are asked to assume responsibility for their bodies, their behavior, their toys, and their pets. Developing a sense of responsibility increases initiative. Uncomfortable guilt feelings may arise, though, if the child is irresponsible and is made to feel too anxious.

Language Development

1. Children of this age are constantly asking mostly “how” and “why” questions. Parents have to answer these questions simply curiosity, vocabulary building and questioning are encouraged.
2. Mealtime conversation is encouraged as preschoolers find this enjoyable and they can describe something from their day in great detail.
3. Parents should correct “bathroom language,” as children of this age imitate language exactly.
4. Adults should watch out their language as preschoolers imitate exactly what they hear and this is the language pattern they adopt.

Play

Children at this age do not need too many toys. The imagination that this age group has is keener than they will be at any other time in their lives. Playing house and games that use imitation ate the ones they enjoy a lot. What preschoolers see that their parents are doing, they imitate. Thus, it is very important that parents and caregivers set a good example to these children. Actions that preschoolers love to imitate are eating meals, mowing the lawn, cleaning the house, arguing and etc.

When playing with other preschooler, they pretend to be teachers, cowboys, firefighters, doctors, nurses, dentists and etc. imaginary friends are normal at this stage because of having an active imagination. Imaginary friends often exist until these children formally begin school.

Antepartum Care

Definition

The antepartum or pre-natal period starts when the woman’s pregnancy is diagnosed and ends just before the baby is delivered. Antepartum care promotes patient education and provides ongoing risk assessment and development of an individualized patient management plan. The major goal of prenatal care is not only to ensure that a healthy baby is born but also to promote the optimum health for the mother.

The following are the goals of antepartum care:

• To evaluate the health status of the mother and the fetus
• To estimate the gestational age
• To identify the patient at risk for complications
• To anticipate problems before they occur and prevent them if possible.
• To promote patient education and communication

Diagnosis of pregnancy

• Commercial kits are available for the diagnosis of pregnancy, all of which depend on detection of human chorionic gonadotropin (hCG) by an antibody. The various techniques used to detect hCG include agglutination inhibition, radioimmunoassay, enzyme-linked immunosorbent assay, and immunochromatography. Some tests can detect hCG at levels as low as 25 mlU/mL or as early as 1 week after implantation.
• Home tests have relatively high positive predictive values. Some of these tests, however, may have high rates of false-negative results.

Estimating Gestational Age

Age of gestation (AOG) should be estimated to calculate the exact date of delivery and the estimated weight and height of the fetus. The following are some estimates of AOG methods:

• Nagele’s Rule
• McDonald’s Method
• Bartholomew’s Rule
• Haase’s Rule
• Johnson’s Rule

Identifying Patient at Risk for Complications

Risk Factors

• Age < 16 or > 35
• 2 spontaneous or induced abortions
• < 8th grade education
• > 5 deliveries
• Abnormal presentation
• Active TB
• Anemia (Hgb <10, Hct <30%)
• Chronic pulmonary disease
• Cigarette smoking
• Endocrinopathy
• Epilepsy
• Heart disease class I or II
• Infants > 4,000 gm
• Isoimmunization (ABO)
• Multiple pregnancy (at term)
• Poor weight gain
• Post-term pregnancy
• Pregnancy without family support
• Preterm labor (34-37 weeks)
• Previous hemorrhage
• Previous pre-eclampsia
• Previous preterm or SGA infant
• Pyelonephritis
• Rh negative
• Second pregnancy in 9 months
• Small pelvis
• Thrombophlebitis
• Uterine scar or malformation
• Venereal disease

Cord Prolapse

Overview of the umbilical cord

The umbilical cord is a flexible, tube-like structure that, during pregnancy, connects the fetus to the mother. The umbilical cord is the baby’s lifeline to the mother. It transports nutrients to the baby and also carries away the baby’s waste products. It is made up of three blood vessels – two arteries and one vein.

Definition

Umbilical Cord Prolapse is an emergency condition where the umbilical cord drops (prolapses) through the open cervix into the vagina ahead of the baby. It is an obstetric emergency during pregnancy or labor that imminently endangers the life of the fetus. Umbilical cord prolapse is a complication that occurs prior to or during delivery of the baby. The cord can then become trapped against the baby’s body during delivery. An umbilical cord prolapse presents a great danger to the fetus. During the delivery, the fetus can put stress on the cord. This can result in a loss of oxygen to the fetus, and may even result in a stillbirth.

Frequency

• Cord prolapse occurs in 0.4 – 0.6 % of deliveries.
• It occurs in 1 of 200 pregnancies

Risk Factors

• Fetal malpresentations
• Premature infants
• Multiparous women

Causes

• A fetus that remains at a high station
• A very small fetus
• Breech presentations. The footling breech is more likely to be complicated because the feet and the legs are small and do not fill well the pelvis.
• Transverse lie
• Polyhydramnios – Excessive amniotic fluid
• Premature rupture of the membranes
• Placenta previa
• Intrauterine tumors preventing the presenting part from engaging
• CPD preventing firm engagement
• Multiple gestation – Delivering more than one baby per pregnancy (twins, triplets, etc.)
• Premature delivery of the baby
• An umbilical cord that is longer than usual

Signs of Cord Prolapse

• The umbilical cord seen or felt during a vaginal examination as it pulsates synchronously with fetal heart
• Fetal bradycardia (sustained) with deceleration (variable) during contraction
• Client reports feeling the cord within the vagina

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Prenatal Development

PRE-EMBRYONIC PERIOD

Cell Division Stage

The first two weeks after conception is called the preembryonic period. By the fourth day after conception takes place, the fertilized ovum is now called zygote. This structure is the one that enters to the uterus. The zygote undergoes cell division that divides into 2, then 4 then 8 cells and so on. The cells become tightly compacted with each division until the 16-cell stage where they occupy the same amount of space as the original zygote. When 12-16 cells are present, the zygote is then called the morula.

The outer cells of the morula (termed as morula because it resembles a mulberry) secrete fluid which forms a balstocyst. A blastocyst is a sac of cells within an inner cell mass placed off within the sac. The inner cell mass develops into the fetus. The outer cell layer develops as the placenta and the fetal membranes.

Zygote Entering the Uterus Period

When the blastocyst contains 100 cells it now enters the uterus. However, implantation does not take place immediately as the blastocyst lingers in the uterus for another 2 to 4 days. During this period, the endometrium is now termed as decidua. The endometrial glands are secreting at their maximum at this time. This is to provide rich fluids to nourish the conceptus before placental circulation is established.

Implantation

Implantation, also called nidation, is the gradual process that occurs between the sixth and the tenth day after conception takes place. During this lengthy process, the embryonic structures continue to develop.

Maintaining the Decidua

Successful implantation and survival of the conceptus would be possible when a continuing supply of estrogen and progesterone is present. To signal the woman’s body that pregnancy has begun, the zygote secretes human chorionic gonadotropin (hCG). The production of hCG by the conception results to the continuous and persistent secretion of estrogen and progesterone by the corpus luteum until the placenta takes over this function at about 8 weeks age of gestation (AOG).

Implantation Location

The best area for implantation and placental development is the upper portion of the uterus. Normal implantation occurs in the upper part of the uterus, more often on the posterior wall than the anterior wall. There are three reasons why the site is ideal:

• The upper portion of the uterus is supplied with blood for optimal fetal gas exchange and nutrition
• The uterine lining is thick in this area which is helpful in preventing the placenta from attaching too deeply into the uterine muscle and facilitating easy expulsion of the placenta after full-term birth.
• When implantation takes place in this area, blood loss is limited because interlacing muscle fibers in this area compress open endometrial vessels after the placenta detaches.