Is defined as the onset of regular painful contraction with progressive cervical dilatation and effacement accompanied by descent of the presenting part

Contractions can occur due to benign conditions (eg, mild dehydration) or serious etiologies (eg, preterm prelabor rupture of membranes, abruptio placentae); therefore, all patients with contractions (regardless of gestational age) require evaluation.

• Braxton-Hicks contractions (false labor)

<aside> 💡 Cervicovaginal fetal fibronectin is secreted during labor and helps distinguish between preterm and false labor in patients with preterm contractions. However, asymptomatic patients do not undergo fFN testing due to high false-positive rates.

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• Digital cervical examination
• Induction of labor vs Augmentation of labor
• First stage of labor is longest

Amniotomy, or iatrogenic rupture of membranes, is no longer routinely performed on patients in spontaneous labor because it does not decrease the duration of the first stage of labor or reduce cesarean delivery rates.

• In patients whose external FHR monitoring poses technical difficulties (e.g., patients with polyhydramnios, uterine leiomyomas, multiple gestation, and/or obesity a Fetal scalp electrode monitoring (FSE monitoring) an invasive (or internal) form of intrapartum fetal heart rate (FHR) monitoring is typically used. FSE monitoring is only performed in patients whose membranes have already ruptured, either spontaneously or via amniotomy. Contraindications for the procedure include active maternal infections (e.g., genital herpes, HIV) and uncertain fetal presentation.
• Second stage of labor

operative vaginal delivery (eg, forceps, vacuum) can be performed to expedite delivery in the setting of a nonreassuring FHR tracing.  It is performed only in patients with complete (10 cm) cervical dilation.

<aside> 💡 Nulliparous patients (primigravidas) experience slower first and second stages of labor compared to parous patients (multigravidas).

Neuraxial anesthesia (eg, epidural) can lengthen the second stage of labor (10 cm cervical dilation until fetal delivery) but not the first stage.

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• Third stage of labor
• Intrapartum fetal Monitoring

Indications for cesarean delivery during the first stage of labor (ie, <10-cm dilation) include a category III fetal heart rate tracing (eg, bradycardia, late decelerations) or arrest of labor (ie, no cervical change for ≥4 hr despite adequate contractions)

• Oxytocin side effects

<aside> 💡 Amniotomy, fetal scalp electrode placement, and operative vaginal delivery are contraindicated in women with HIV, hepatitis B, and hepatitis C.  These procedures can break the protective fetal skin barrier, increasing the risk of vertical transmission.

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Regional neuraxial anesthesia is preferred for cesarean delivery because general anesthesia (ie, intubation) causes maternal sedation and has additional risks (eg, aspiration pneumonia).

Epidural analgesia

HSV in Pregnancy