PRE-EMINENT SIGNS OF

LABOR AND TRUE VS FALSE

LABOR
GROUP 1 CASE PRESENTATION

MEMBER
S
Amurao, Lindzy Aguisanda, Geneva
Antiporda, Alex Barrios, Maritoni
Bendijo, Honney Bere, Gillianne
Bermudez, Sasha Biscocho, Alaina
 Maria is a 34-year-old G1P0 38 4/7 weeks AOG, she
CASE came into the clinic this morning for abdominal pain.
During interview she said that she feels like she is

SCENARIO having uterine contractions but is unsure if it is really

happening. She also said that she feels it whenever she
is moving around the house but goes away when she is
at rest. She has been feeling this since last night. She
denies bloody show and ruptured bag of water.

The nurse did an internal examination, it reveals the

following findings:
• Cervical os: closed
• Effacement: 0
• Station: Floating
• Membranes: Intact
She was ordered by her doctor to go home, ambulate
for 30 minutes every 4 hours during day time and come
back if the contractions become more regular. Maria
went home.

The next morning, Maria went back to the clinic to

report that she is having uterine contractions every 4 to
5 minutes, lasting for about 1 minute. She also reported
bloody show and a sudden gush of fluid from her
vaginal area while in the vehicle going to the clinic.

The nurse did an IE and it reveals:

• Cervical os: 5 cms
• Effacement: 80%
• Station = +3
• Membranes: Spontaneous rupture
SHE IS HOOKED TO THE FETAL MONITOR AND HER
INITIAL NST SHOWS:
 Please admit to labor room
Start NPO
THE DOCTOR
ORDERED THE IV Fluids:
• PNSS 1 L to run for 100 ml/hour
FOLLOWING: • Side drip, D5NR 1L + 10 units syntocinon 10 units at 8
drops per minute to titrate accordingly

Medications:
• Buscopan 20 mg IV every 2 hours to complete 3 doses
• Hooked to fetal monitor
• Sterile gloves for internal examination
• Please refer to anesthesiologist for epidural anesthesia as
planned
• Please refer pediatrician of this admission
 YOU ARE THE DELIVERY
ROOM NURSE, AND YOU
WOULD LIKE TO INFORM
YOUR PATIENTS REGARDING
THE DIFFERENCE BETWEEN
TRUE AND FALSE LABOR.
CREATE A FLYER OR A
PAMPHLET RE: TRUE AND
FALSE LABOR. MAKE IT
CREATIVE AND INTERESTING
DESCRIBE THE
RESULT OF THE
NON-STRESS
TEST.
Nonstress test is used to evaluate a baby’s health before birth. The goal of
a nonstress test is to provide useful information about your baby’s oxygen
supply by checking its heart rate and how it responds to your baby’s
movement. The test might indicate the need for further monitoring, testing
or delivery. 
This test can be classified as normal, atypical, or abnormal. A normal non
stress test will show a baseline fetal heart rate between 110 and 160 beats
per minute with moderate variability (5- to 25-interbeat variability) and 2
qualifying accelerations in 20 minutes with no decelerations.
The normal FHR range is between 120 and 160 beats per minute (bpm). When reviewing the tracing of the FHR (fetal heart
rate) that uses patterns to describe it:

• BASELINE – interpreted as changed if the alteration persists for more than 10 minutes

• VARIABILITY – fluctuations in the FHR baseline of 2 cycles per minute or greater, with irregular amplitude and inconstant
frequency

• FETAL TACHYCARDIA – defined as a baseline heart rate greater than 160 bpm
• FETAL BRADYCARDIA – defined as a baseline heart rate less than 120 bpm
• ACCELERATIONS – are short-term rises in the heart rate of at least 15 beats per minute, lasting at least 15 seconds. The
presence of accelerations is considered a reassuring sign of fetal well-being
• DECELERATIONS – are temporary drops in the fetal heart rate. There are three basic types of decelerations: early decelerations,
late decelerations, and variable decelerations.

1. EARLY DECELERATIONS – begin before the peak of the contraction, often happens during later stages of labor as the
baby is descending through the birth canal

2. LATE DECELERATIONS – don’t begin until the peak of a contraction or after the uterine contraction is finished

3. VARIABLE DECELERATIONS – happen when the baby’s umbilical cord is temporarily compressed, happens during
most labors
Monitoring uterine pressure during labor is important because strong uterine contractions are what
allows the pregnant woman to safely deliver the fetus. It will need to know how long your
contractions last (duration) and how close together they are (frequency).

• FREQUENCY – is timed from the start of one contraction to the start of the next. It includes the
contraction as well as the rest period until the next contraction begins; measured by minutes
• DURATION – timed from when you first feel a contraction until it is over; measured in seconds 
INTERPRETATION
In the NST, the baseline heart rate was set at 120bpm as the peak was at 150 and the trough of the heart rate
was at 110. The variability is moderate since the variability is 25 bpm (more than 25 bpm for more than 25
minutes is considered abnormal). 

• Reassuring FHR 

• Heart rate: 110 to 150 bpm

• Baseline: 120 bpm 

• Variability: 5-25 bpm (moderate variability)

• Accelerations: none

• Decelerations: Variable deceleration

Her uterine contractions showed that the frequency of the contractions was 2 times in every 10-minute
period. Each duration of contraction lasts about 30 seconds. That means her uterine contractions are
considered normal contractions.
 CREATE A
DRUG STUDY
FOR THIS
CASE
Explain why the physician
ordered for Maria to go
home at first and then
ordered to admit her the
next day.
The patient was asked to go home first to ambulate by her doctor. The
reason for ambulation or upright position is having light activities to
reduce the amount of time Maria spends laying down during this stage and
it helps speed dilation by increasing blood flow. Walking around the room,
doing simple movements in bed or chair, or even changing positions may
encourage dilation. This is because the weight of the baby applies pressure
to the cervix and will cause the contractions to become regular.
 EXPLAIN THE
RESULT OF THE
INTERNAL
EXAMINATION
INTERNAL EXAMINATION:
Cervical OS: closed
Effacement: 0
Station: floating
Membranes: Intact 
According to the given IE, the Cervical OS of the patient is closed which means that the
cervix is not yet dilated. The effacement is 0 which means that the cervical canal is not
effaced at all. In the station, the result is floating which means that when the physician
examined the cervical canal of the patient, the doctor felt the baby’s head. If the head is high
and not yet engaged in the birth canal, It’ll float away from the physician’s fingers. Lastly,
the membranes are still intact which prevents the entry of the infective organisms. 
INTERNAL EXAMINATION:
Cervical OS: 5cm
Effacement: 80%
Satiation: +3
Membranes: spontaneous rupture
After doing an IE to the patient, It results that the patient's cervical OS is 5cm which means that the
patient is currently in the active stage of labors; once the cervix dilates to 5cm, contractions begin
to get longer, stronger and closer together. The effacement is 80% which means that it’s almost
short enough to allow your baby to through the uterus. It also shows that the fetal station of the
baby is +3 which indicates that the baby has descended beyond the ischial spines or within the birth
canal. Lastly, It also revealed that the membrane has spontaneous rupture or what they call “water
broke”. It usually happens after the active labor has started. With that, you should ask you doctor or
midwife immediately and to check if your water really did break.
 WHY DOES THE
DOCTOR ORDERED
TO USE STERILE
GLOVES DURING
INTERNAL
EXAMINATION?
 Sterile gloves are gloves that are free from all microorganisms. They are required for any invasive
procedure and when contact with any sterile site, tissue, or body cavity is expected (PIDAC, 2012). Sterile
gloves help prevent surgical site infections and reduce the risk of exposure to blood and body fluid
pathogens for the health care worker. Studies have shown that 18% to 35% of all sterile gloves have tiny
holes after surgery, and up to 80% of the tiny puncture sites go unnoticed by the surgeon (Kennedy, 2013).
Double gloving is known to reduce the risk of exposure and has become common practice, but does not
reduce the risk of cross-contamination after surgery (Kennedy, 2013).

Sterile gloves also help to prevent infection by limiting microorganism transmission between health
care workers and patients. They serve as a defense against harmful germs such as bacteria and viruses.

Medical gloves are disposable gloves used to avoid cross-contamination between caregivers and
patients during medical examinations and procedures. Medical gloves are constructed of a variety of
polymers, including latex, nitrile rubber, polyvinyl chloride, and neoprene; they are available unpowdered
or powdered with cornstarch to make them simpler to put on the hands.
WHEN SHOULD YOU USE STERILE GLOVES? 

Sterile medical gloves must be used when coming into contact with
a sterile area, tissue, or bodily cavity. They're essential for nearly
every surgical procedure and intrusive interaction with the human
body. Surgical personnel must use disposable sterile gloves because
skin cannot be sterilized.
STERILE GLOVE SAFETY

1. Choose tight-fitting gloves. Picking up objects, such as surgical instruments, should be

easy. These gloves come in multiple sizes. Make sure you choose the size that is right for
your hand fit.
2. Always wash hands before putting on sterile gloves and immediately after their removal.
Wearing sterile gloves does not replace protective handwashing. Gloves are not a substitute
for good hand hygiene.
3. Make sure all tools and supplies are ready before donning gloves.
4. Practice latex allergy precautions by asking the patient ahead of time if they are allergic or
choose another type of latex free sterile gloves to use devoid of latex proteins.
STERILE GLOVES: HOW TO PUT THEM ON 

Step 1: Take off all your jewelry. 

Step 2: Do not use artificial nails, long nails, or nail polish on your fingers. 

Step 3: Cover any open wounds or abrasions with bandages. Check for open lesions or skin fractures on your hands. 

Step 4: Either wear short sleeves or fold the sleeves up 2-3 inches above the elbows.

Step 5: Use a surgical hand scrub to thoroughly clean your hands. 

Step 6: Prepare to open a sterile glove package by cleaning a surface. Above the waist, keep all sterile goods. 

Step 7: Make sure the glove package is dry, not expired, and complete. It should not be torn or show signs of having been opened. 

Step 8: Peel the packaging open from top to bottom to avoid damaging the contents.

Step 9: Open the inside package and place it on the designated work surface. 

Step 10: Using only the inner cuff, pick up the dominant hand's glove and pull it all the way up to the wrist, avoiding any contact with the outside of
the glove. 

Step 11: Only touch the inside cuff of the remaining glove with your gloved hand, then draw it up to the wrist with your non-dominant hand. 

Step 12: Hold gloved hands together above waist level and at least 6 inches (15.24 cm) away from clothing and surfaces to avoid touching non-sterile
objects when wearing sterile gloves.
 WHAT IS AN
EPIDURAL
ANESTHESIA?
An epidural anesthesia is a type of pain relief for women in labor or who are
usually having a CS and in some types of surgery. An epidural is a procedure that
injects a local anesthetic into the space around the spinal nerves on the lower back.
This anesthetic blocks the pain from labor contractions and during childbirth very
effectively. With an epidural, you can usually move and can push your baby out
when you need to. An epidural is usually done by a specialist doctor called an
anesthetist. Epidurals are available at most hospitals but not in birth centers or for
home births. Whether the patient has an epidural or not makes no difference to the
chance of having a CS. 
THE PROCEDURE
1. Before an epidural, the patient will usually have a drip for fluids put into the arm.

2. You’ll be asked to sit down and lean forwards or lie on your side with your knees up close to
your chest.

3. You'll be given an injection of a local anesthetic to numb the skin where the epidural will be
inserted.

4. A needle is used to insert a fine plastic tube called an epidural catheter into your back (spine)
near the nerves that carry pain messages to your brain.

5. The needle is then removed, leaving just the catheter in your spine.

6. You may feel mild discomfort when the epidural needle is positioned and the catheter is
inserted.

7. It usually takes between 5 and 30 minutes for the pain to be relieved by the epidural.

8. The patient usually only has an epidural during the first stage of labor — but it can be given at
any stage of labor.
 ADVANTAGES AND DISADVANTAGES OF AN EPIDURAL

ADVANTAGES DISADVANTAGES
• It is usually very effective • For medical reasons, not everyone can have
an epidural
• It is generally very safe • You might need to have fluids given to you
through a tube in your arm, and will need to
• You can often still move around in bed and have your blood pressure monitored
push when you need to • You might lose feeling in your bladder and
need a catheter (tube) in your bladder to help
• If you have a long labor, it allows you to you pass urine
sleep and recover your strength • You might lose feeling in your legs for a few
hours
• If you're having a cesarean, you can stay • It might slow down the second stage of labor
awake and your partner can be there • You might not be able to push and need help
to give birth
• Your baby will need to be closely monitored
during your labor
RISKS AND SIDE EFFECTS

• Some women feel cold or itchy.

• A small number of women get little or no pain relief.
• Some women get weakness in the legs; it wears off after a few hours.
• There is an increased risk of needing forceps or a vacuum to help with the birth.
• Some women develop a bad headache 24 to 48 hours after an epidural.
• There is a small chance of developing a skin infection.
• Very rarely a few women get permanent nerve damage.
 CREATE A
PRIORITY NCP
FOR THE
PATIENT
 ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
SUBJECTIVE DATA

The patient stated that:

• She feels like she is having

uterine contractions but
is unsure if it is really
happening

• She is having abdominal

pain
• She feels it whenever she
is moving around the
house but goes away
when she is at rest

• She feels it whenever she

is moving around the
house but goes away
when she is at rest

• Bloody show and a

sudden gush of fluid from
her vaginal area while in
the vehicle going to the
clinic
 ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
OBJECTIVE DATA

• Uterine contractions
every 4 to 5 minutes,
lasting for about 1 minute

• Cervical os: 5 cms

• Effacement: 80%

• Station = +3

• Membranes:

• Spontaneous rupture
REFERENCES
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