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labor
Clinical manifestations:
1) lightening occurs when the baby drops or settles lower in the pelvis
a) dyspnea may lessen because the lungs have more room to expand
b) increased pressure in the pelvis
c) urinary frequency may increase
d) usually occurs several weeks prior to first delivery
e) in subsequent births, it may happen hours before delivery
2) bloody show
a) as the cervix thins & starts to dilate, small capillaries burst & cause a small quantity of pink or brown vaginal discharge
- vaginal bleeding is abnormal
b) the mucous plug, which has sealed the cervix throughout pregnancy, dislodges
c) can occur anywhere from hours to several weeks before delivery
3) nesting instinct
- some women notice a burst of energy a few days prior to going into labor
4) nausea & diarrhea
5) abdominal cramping
6) increased Braxton Hicks contractions
Management:
- epidural analgesia associated with 35% lower severe maternal morbidity [2]
- most pronounced among women with risk factors* or preterm delivery
* risk factors for severe maternal morbidity
- preexisting severe cardiac disease or respiratory disease, preeclampsia, multifetal gestation, morbid obesity (BMI > 40), previous caesarian section, or breech presentation [2]
Related
induction of labor
Labor Pain
Specific
labor & delivery
premature labor; preterm labor
rupture of membranes
General
physiologic process
References
- eMedicinehealth: Labor signs
http://www.emedicinehealth.com/labor_signs/article_em.htm
- Kearns RJ, Kyzayeva A, Halliday LOE, Lawlor DA, Shaw M, Nelson SM.
Epidural analgesia during labour and severe maternal morbidity: population based study.
BMJ. 2024 May 22;385:e077190.
PMID: 38777357 PMCID: PMC11109902 Free PMC article.
https://www.bmj.com/content/385/bmj-2023-077190