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PREMONITORY SIGNS OF LABOR

1. Lightening
This is the descent/setting of the presenting part into the pelvic
inlet which happens 10-14 days before labor in primigravida and 1 day
before labor in a multipara. And when the largest diameter of the
presenting part passes the pelvic inlet, the head is said to be
engaged. However, lightening is heralded by the following signs:
• Relief of dyspnea
• Relief of abdominal tightness
• Increased frequency of voiding
• Increased amount of vaginal discharge
• Increased lordosis as the fetus enters the pelvis and falls
further forward
• Increased varicosities
• Shooting pains down the legs because of pressure on the
sciatic nerve

2. Increased Braxton Hick’s contractions in the last week or days


before labor
These are false labor contractions, painless, irregular, abdominal
and relieved by walking, and are also known as practice
contractions.

3. A sudden burst of maternal energy/activity because of hormone


epinephrine. This is meant to prepare the body for the “labor” ahead.

4. Slight decrease is maternal weight. Loss of weight is about 2-3 lbs.


One to two days before the onset of labor because of the decrease in
progesterone level and probably loss of appetite.
5. Softening/”ripening” of the cervix

SIGNS OF TRUE LABOR


1. Uterine contractions
The surest sign that labor has begun is the initiation of effective,
productive, involuntary uterine contractions.
There are 3 phases of uterine contractions:
a. Increment/Crescendo – intensity of the contraction
increases
b. Apex/Acme – the height or peak of the contraction
c. Decrement/Decrescendo – intensity of the
contraction decreases
Characteristics of contractions:
 Frequency of contraction – this is timed from the
beginning of one contraction to the beginning of the next.
 Duration of contraction – this is timed from the moment
the uterus first begins to tighten until it relaxes again.
 Intensity of contraction – it may be mild, moderate or
strong at its acme.
a. Mild contraction – the uterine muscle becomes
somewhat tense, but can be indented with gentle
pressure.
b. Moderate contraction – the uterus becomes
moderately firm and a firmer pressure is needed
to indent.
c. Strong contraction – the uterus becomes so firm
that it has the feel of wood like hardness, and at
the height of the contraction, the uterus cannot
be indented when pressure is applied by the
examiner’s finger.

2. Uterine changes
As labor contractions progress, the uterus is gradually
differentiated into two distinct portions. These are distinguished by a
ridge formed in the inner uterine surface, the physiologic retraction
ring.
a. Upper uterine segment – this portion becomes thicker and
active, preparing it to exert the strength necessary to expel
the fetus during the expulsion phase.
b. Lower uterine segment – this portion becomes thin-walled,
supple, and passive so that the fetus can be pushed cut of the
uterus easily.
c. Contour of the uterus changes from a round ovoid to a
structure markedly elongated in a vertical diameter than
horizontally. This serves to straighten the body of the fetus
and place it in better alignment to the cervix and pelvis.

3. Cervical changes
There are 2 changes that occur in the cervix
a. Effacement – This is the shortening and thinning of the
cervical canal to paper-thin edges. To primiparas,
effacement is accomplished before dilatation begins
while with multiparas, dilatation may proceed before
effacement is complete.
b. Dilatation – This refers to the enlargement of the
cervical canal from an opening a few millimeters wide to
one large enough (approx. 10 cm) to permit passage of
the fetus.
Dilatation occurs for two reasons. First, uterine
contractions gradually increase the diameter of the
cervical canal lumen by pulling the cervix up over the
presenting part of the fetus. Second, the fluid-filled
membranes press against the cervix.

4. Show
This is the blood-tinged mucus discharged from the vagina
because of pressure of the descending fetal part on the cervical
capillaries causing their rupture. Capillary blood mixes mucus when
operculum is released.

5. Rupture of the membrane of bag of waters


This is a sudden gush or a scanty slow seeping of amniotic fluid
from the vagina. The color of the amniotic fluid should always be
noted. At term, this is clear, almost colorless and contains white specks
of vernix caseosa. Green staining means it has been contaminated
with meconium. Yellow staining may mean blood incompatibility while
pink staining may indicate bleeding.
Once membranes have ruptured, labor is inevitable, meaning to
say that uterine contractions will occur within next 24 hours. The initial
nursing actions for patients with ruptured membranes are:
• Notify physician
• Lie patient to bed to ensure that the fetus is not impinging
on the cord.
• Check the fetal heart rate to determine for fetal distress.
• If the patient claims she can feel a loop of the cord coming
out of her vagina (umbilical cord prolapsed), lower the
head of the bed (Trendelenberg position) in order to
release pressure on the cord. Also apply sterile, saline-
saturated gauze to prevent drying of the cord, if needed.
If labor does not occur spontaneously at the end of
24 hours after membrane rupture, it will be induced,
provided the woman is estimated to be at term.