Bedside ultrasound can be employed to confirm the presentation and position of the fetal presenting part. During the cervical exam, confirmation of the presenting fetal part is also necessary. Effacement is measured by estimating the percentage remaining of the length of the thinned cervix compared to the uneffaced cervix. The measurement of cervical dilation is made by locating the external cervical os and spreading one's fingers in a ‘V’ shape, and estimating the distance in centimeters between the two fingers. A sterile gloved exam should be done to determine the degree of cervical dilation and effacement. Amniotic fluid has a pH of 7.0 to 7.5, which is more basic than normal vaginal pH. If the clinician is unsure whether or not a rupture of membranes has occurred, additional testing such as pH testing, microscopic exam looking for ferning of the fluid, or laboratory testing of the fluid can be the next step. Finally, a history of present illness, review of systems, and physical exam, including a sterile speculum exam, will need to take place.ĭuring the sterile speculum exam, clinicians will look for signs of rupture of membranes such as amniotic fluid pooling in the posterior vaginal canal. The patient's prenatal record, including obstetric history, surgical history, medical history, laboratory, and imaging data, should undergo review. The patient should be placed on continuous cardiotocographic monitoring to ensure fetal wellbeing. When women first present to the labor and delivery unit, vital signs, including temperature, heart rate, oxygen saturation, respiratory rate, and blood pressure, should be obtained and reviewed for any abnormalities. It is up to the clinician to determine if the patient is in labor, defined as regular, clinically significant contractions with an objective change in cervical dilation and/or effacement. Common chief complaints include painful contractions, vaginal bleeding/bloody show, and fluid leakage from the vagina. Women will often self-present to obstetrical triage with concern for the onset of labor. Initial Evaluation and Presentation of Labor Medical professionals use the information they obtain from monitoring and cervical exams to determine the patient's stage of labor and monitor labor progression. Cardiotocography is used to monitor the frequency and adequacy of contractions. Fetal heart monitoring is employed nearly continuously to assess fetal well-being throughout labor.
#TRANSITION PHASE OF LABOR SERIAL#
Serial cervical examinations are used to determine cervical dilation, effacement, and fetal position, also known as the station.
Clinicians typically use multiple modalities to monitor labor. This triad is classically referred to as the passenger, power, and passage. Successful labor involves three factors: maternal efforts and uterine contractions, fetal characteristics, and pelvic anatomy. The first stage is further divided into two phases. Labor is the process through which a fetus and placenta are delivered from the uterus through the vagina.
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