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Management of Labour
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
Prelabour, a few days to 1 or 2 weeks before labour, a woman may feel lightening. This is a feeling of lightness or relief in the upper abdomen as the head descends to fix or engage in the pelvis. This is more so in a primigravida. She may also experience backache frequently, along with slightly increased vaginal discharge. This is due to slightly enhanced Braxton Hicks contractions and the prelabour softening, effacement of the cervix (maturation of the cervix), and filling up of the lower segment by the presenting part.
The diagnosis and management of preterm labor with intact membranes
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Roberto Romero, Tinnakorn Chaiworapongsa, Francesca Gotsch, Lami Yeo, Ichchha Madan, Sonia S. Hassan
With the introduction and widespread utilization of tocolytic agents, several definitions of preterm labor were proposed. Notably, in 1975, Ingemar Ingemarsson (154) proposed that the criteria for the diagnosis should include (i) painful regular uterine contractions occurring at intervals of less than 10 minutes for at least 30 minutes by external tocography, (ii) a cervix that is effaced or almost effaced and dilated at least 1 to 2cm, (iii) intact membranes, and (iv) a gestational age between 28 and 36 weeks. This definition was the basis for a randomized, double-blinded clinical trial of terbutaline in women with preterm labor and intact membranes (154). The gestational age limitation reflected neonatal survival at the time. Importantly, two components of the common pathway were required for the diagnosis (increased myometrial contractility and cervical change). Gonik and Creasy wrote a clinical opinion in 1986 (155), in which they proposed a definition of preterm labor that has been used subsequently in the literature. The definition is based on uterine contractility and cervical change, and was proposed to select patients for tocolytic treatment. A change in cervical status was required because of the concern about overtreating patients with painful Braxton-Hicks contractions without other evidence of preterm labor (156–158).
The context of birth
Published in Helen Baston, Midwifery, 2020
The cervix is the gatekeeper, holding the fetus in the uterus. For the baby to be born, the cervix needs to become fully dilated to enable the baby to pass from the uterus, through the vagina and to the outside world. In obstetric terms the dilatation of the cervix is measured from closed (0 cm) to fully open (10 cm) and this is usually assessed by regular vaginal examinations. During pregnancy, the cervix of the primigravid woman is closed and has thickness, somewhat like a doughnut with a closed hole in shape. Towards the end of pregnancy, the woman will experience ‘Braxton-Hicks’ contractions, which are usually painless uterine contractions. These herald the beginning of the long process of softening and preparing the cervix for dilatation, but they may be experienced for several weeks before labour starts.
Impact of Braxton-Hicks contractions on fetal wellbeing; a prospective analysis through computerised cardiotocography
Published in Journal of Obstetrics and Gynaecology, 2022
Marco La Verde, Gaetano Riemma, Marco Torella, Clelia Torre, Stefano Cianci, Anna Conte, Carlo Capristo, Maddalena Morlando, Nicola Colacurci, Pasquale De Franciscis
Labour is identified by intense, consistent, and rhythmic, uterine contraction due to myometrial electrical coupling within gap junctions (Garfield et al. 1998). The increasing myocyte connectivity reached leads up to labour (Renthal et al. 2013). When an ample area of the myometrium is depolarised, there is a raised intrauterine pressure that tightens the uterine wall (Smith et al. 2015). This stretch induces depolarisation of the rest of the uterus, allowing the synchronous contractions (Wolfs and van Leeuwen 1979). Before establishing the active labour, frequent painful contractions felt by women in the third trimester, defined Braxton-Hicks contractions (BHC), can occur. BHC represent spots of uterine action in the absence of enough gap-junction connectivity. These contractions can increase in frequency towards the term of pregnancy and are often distinguished by the mothers. During pregnancy, the mother’s heart redirects a large volume of blood flow to the uterus. This increased blood flow has the main function to develop the foetus (Costantine 2014).
Recurrence of Basal Plate Myofibers, with Further Consideration of Pathogenesis
Published in Fetal and Pediatric Pathology, 2019
Debra S. Heller, Rachel Wyand, Stewart Cramer
The first evidence of pre-delivery basal plate damage in BPMF placentas lacking a clinical diagnosis of placenta accreta was the observation of decidual hemosiderosis by Stanek and Drummond (14). In confirming this observation, we previously suggested that perhaps damage occurred during Braxton-Hicks contractions, with hemosiderosis evolving from preexisting red blood cell extravasation in the basal plate (Figure 5). Ernst and coworkers later demonstrated association of clinical placenta accreta with other placental and basal plate pathology, including plasma cell deciduitis and evidence of low uteroplacental blood flow (multiple infarcts) (9). The present study supports those previous observations (9).