CONFIRMATION OF LABOR

•	Definition.
•	Differentiation. 
•	Admission to labor ward.

Definition

1.	Labor is defined as the onset of painful, regular contractions occurring at least 1 in 10 minutes.

2.	It is associated with progressive effacement and dilatation of the cervix accompanied by descent of the presenting part.

3.	There may or may not be a:

a.	Show: the release from the cervix of a blood-stained mucus plug, which is then expelled from the vagina.

b.	Leaking liquor: release of amniotic fluid due to rupture of the membrane. 

Importance of diagnosing onset of labor

1.	Allow progress with a view to normal delivery.

2.	Recognize false labor and allow the patient to go home after confirming fetal well-being.

3.	Recognize pre-term labor with the intent to inhibit labor.

4.	Recognize high-risk labor that needs to be supervised vigilantly.

5.	Identify when labor or vaginal delivery is contraindicated, e.g. in cases of two previous LSCS or placenta praevia major, so that the pregnancy can be terminated abdominally.

Differentiating true from false labor

True labor	False labor	
The contractions occur at regular intervals of at least one in every 10 minutes.	The contractions occur at irregular intervals.	
The intervals gradually shorten to two to four minutes apart.	The intervals are long.	
The duration of the contractions gradually increases, lasting up to one minute	The intensity of contractions remain the same.	
The contractions are painful and not affected by sedation.	The contractions are relieved by sedation.	
There is progressive effacement and dilatation of the cervix.	There are no progressive changes in the cervix.	
There may be show and leaking of liquor but on their own, these are not diagnostic of labor.	The contractions gradually abate.	

Follow-up action

1.	Gestational age < 37 weeks:

a.	< 34 weeks: exclude contraindications and inhibit labor.

b.	> 34 weeks: alert neonatal paediatrician and allow progress of labor if no contraindication for vaginal delivery.

2.	Gestational age > 37 weeks:

a.	Vaginal delivery is contraindicated: emergency LSCS.

b.	Vaginal delivery not contraindicated: allow labor to progress.

Admission in labor at term

1.	Admission test:

a.	CTG for 20 minutes and review trace.

b.	Check growth of fetus clinically and inquire about fetal movements.

2.	Contractions 1 in 5 min or more or painful contractions of any frequency needing analgesia: admit to ward.

3.	Contractions which are not painful and less than 1 in 5 min with reactive CTG and no antenatal complications:

Parity	Cervical score	Action	
Nullip	< 3	Home with FM chart & ANC.	
	4 – 6	Antenatal ward.	
	> 7	Remain in labor ward.	
Multip	< 3	Antenatal ward.	
	> 4	Remain in labor ward. 	

4.	Well-established labor:

a.	Patient admitted in active phase of labor or distressed with painful contractions in latent phase.

b.	20 min CTG – if reactive and normal.

c.	Commence partogram after abdominal examination and VE and institute fetal monitoring.