Labor: True and False

There are pleliminary events to labor :

• Backache
• Cervix becomes soft and effaced and may begin to dilate
• Braxton Hicks contraction increase
• Lightening or dropping
• Membranes may rupture spontaneously
• Vaginal secretions increase
• Urinary frequency increases
• Passage of mucous plug occurs
• Weight loss of 1 – 3 lb
• “Bloody show” occurs
• Mother has a sudden burst of energy

How to differentiate between true labor and false labor?

True Labor:

• Contractions are in the back and abdomen
• Contractions are regular with decreasing intervals
• Contractions increase over time and increase with walking, and little or no effect from sedation
• Cervical dilation and effacement are progressive

False Labor:

• Contractions are in lower abdomen
• Contractions are irregular with unchanging or increasing intervals
• Contractions remain the same, unaffected by, or decrease with walking and relieved by sedation
• No dilation or effacement or cervix

COMPLICATION OF PREGNANCY

ABRUPTIO PLACENTAE
Abruptio Placentae is premature detachment of a normally situated placenta. Patient with abruption placentae will have bleeding, abdominal pain, boardlike uterus, maternal hypotension and tachycardia and fetal distress. Nursing managements will include: bed rest, monitor bleeding and shock, monitor fetal heart rate continuously.

ECLAMPSIA
Complication with seizures between 20th week of pregnancy and first postpartal week. Eclampsia can be happened with or following pregnancy-induced hypertension. Management of eclampsia will include giving magnesium sulfate, frequently assess vital signs, restrict fluid intake hourly to a total of 125 mL/h, and urinary output should be at least 30 mL/h.

GESTATIONAL DIABETES
Gestational diabetes occurs in 3–6% of all pregnancies, and although it typically resolves after delivery, it increases the risk of maternal pyelonephritis and of certain congenital anomalies, and is often associated with polyhydramnios and fetal macrosomia, with resultant dystocia. Patient will have polyuria, polydipsia and polyphagia. Gestational diabetes can be diagnosed with 3 hours Glucose Tolerance Test after 100 grams load. Management: exercise, dietary management, insulin (if needed), monitoring of weight, and teach and to assess glucose monitoring and diet.


PLACENTA PREVIA
Placenta previa is the condition in which the placenta is implanted in the lower segment of the uterus, extending to the margin of the internal os of the cervix or partially or completely obstructing the os. Clinical sign of placenta previa is painless vaginal bleeding. Management: monitor maternal vital signs, bed rest, monitor fetal heart rate, and not performing vaginal examination if placenta previa is suspected.

GROUP B STREPTOCOCCAL INFECTION
It would be 10-30% of pregnant women are colonized which are asymptomatic. It is recommended screening by rectovaginal swab at 37 weeks of gestation.

PREGNANCY-INDUCED HYPERTENSION (PIH)
PIH is a syndrome of hypertension, edema, and proteinuria that can occurs after 20th week of pregnancy. This patient will have headache, blood pressure of 140/90 or greater, or an increase of 30 mm Hg systolic or 15 mm Hg diastolic at two readings and edema that not relieved by bed rest, proteinuria, weight gain above 2 lb / weeks, visual disturbance, and epigastric pain. Patient who has pregnancy-induced hypertension will be managed by bed rest, control blood pressure, antihypertensive medicines, monitor intake and output, daily weight, and check urine for protein.

HELLP SYNDROME
This is a type of severe preeclampsia involving hemolysis, elevated liver function, and low platelets. Patient should delivery soon.

PRETERM LABOR
Preterm labor is a labor between 20 and 37 weeks of gestation.