Pregnant women are urged to report early in labor rather than to procrastinate until delivery is imminent for fear that they might be experiencing false labor. Early admittance is especially important if during antepartum care the woman, her fetus, or both are found to have risk factors for intrapartum complica tions.
Although the diferentiation between false and true labor is diicult at times, the diagnosis usually can be clariied by contraction frequency and intensity and by cervical dilation. Pates and associates (2007) studied one commonly used recommendation given to pregnant women. Namely, in the absence of ruptured membranes or bleeding, uterine contractions 5 minutes apart for 1 hour-that is, ::12 contractions in 1 hourmay signiY labor onset. Among 768 women in this study at Parkland Hospital, active labor deined as cervical dilation ::4 cm was diagnosed within 24 hours in three fourths of women with ::12 contractions per hour. Bailit and coworkers (2005) compared labor outcomes of 6121 women who presented in active labor deined as uterine contractions plus cervical dilation ::4 cm with those of 2697 women who presented in the latent phase. Women admitted during latent-phase labor had more active-phase arrest, more frequent need for oxytocin labor stimulation, and higher rates of chorioamnionitis. It was concluded that physician interventions in women presenting in the latent phase may have been the cause of subsequent labor abnormalities.
In those instances when a diagnosis of labor cannot be established with certainty, observation for a longer period is often wise. Women who present to Parkland Hospital for labor 24°/7 ,. .
symptoms at weeks gestatIon or greater are routmely evaluated in a labor triage unit contiguous to our labor and delivery unit. All women in the triage area are evaluated by nurse practitioners and certiied nurse midwives using written protocols. Women with uncomplicated pregnancies with intact membranes and cervical dilation < 4 cm receive continuous external fetal monitoring for up to 2 hours. Women diagnosed with labor by either cervical change or persistent uterine contractions are admitted. After review by a physician, women without cervical change or with abatement of contractions return home with a diagnosis of false labor. In a recent study, a total of 3949 women with uncomplicated pregnancies between and 416r weeks' gestation were diagnosed with false labor. The mean inteval from hospital discharge to when they again presented was 4.9 days (Nelson, 2017). Within this protocol, hospital discharge with false labor at term was not associated with higher rates of adverse neonatal outcomes or cesarean delivery. he American College of Obstetricians and Gynecologists (2016a) has endorsed hospital-based obstetrical triage units.
Maternal blood pressure, temperature, pulse, and respiratory rate are recorded. Fetal heart rate is evaluated using a portable Doppler device, sonography, or fetoscope. The pregnancy record is promptly reviewed to identiY complications. Problems identiied or anticipated during prenatal care should be displayed prominently in the pregnancy record. Most often, unless there has been bleeding in excess of bloody show, a cervical examination is performed. he gloved index and second ingers are introduced into the vagina while avoiding the anal region.
During prenatal care, the woman is instructed to be aware of luid leakage from the vagina and to report such an event promptly. Rupture of the membranes is signiicant for three reasons. First, if the presenting part is not ixed in the pelvis, the umbilical cord can prolapse and be compressed. Second, labor is likely to begin soon if the pregnancy is at or near term.
hird, if delivery is delayed after membrane rupture, intrauter ine and neonatal infection is more likely as the time interval increases (Herbst, 2007).