Which of the following are signs of true labour?

RUHS, Jaipur, M.Sc Nursing Entrance Exam-2015

Obstetrics & Gynaecology

Easy

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2015

Explanation

True labour is defined by a triad of signs: regular, painful uterine contractions that increase in intensity and frequency; the presence of 'show' (blood-tinged mucus); and most importantly, progressive cervical dilatation.
Painful uterine contractions in true labour are distinct from Braxton Hicks contractions (false labour) as they become more organized and intense over time and are not relieved by rest or change in position.
The 'show' is the expulsion of the mucus plug that has sealed the cervix during pregnancy. Its presence indicates that the cervix is beginning to change (efface and dilate).
Progressive dilatation of the cervix is the most conclusive and definitive sign of true labour. It signifies that the uterine contractions are effective in opening the cervix to allow for the passage of the fetus.

Option B: This option includes 'taking up of cervix' (effacement). While effacement is a necessary part of labour, it can occur gradually over days or weeks before true labour begins, especially in primigravid women. It is not a definitive sign of active labour on its own.
Option C: This option includes 'lightening'. Lightening is the descent of the fetal head into the pelvis, which typically occurs 2-3 weeks before the onset of labour in primigravidas. It is a premonitory (pre-labour) sign, not a sign of active labour.
Option D: This option includes 'rupture of membrane'. The amniotic sac can rupture before, during, or even just before birth. If it ruptures before the onset of contractions, it is called Premature Rupture of Membranes (PROM). Therefore, it is not a defining sign of the start of labour.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Differentiating between the signs of true and false labour as background academic context rather than a clinical decision trigger.
A nurse's primary role in the triage of a pregnant woman is to accurately differentiate between true and false labour to ensure appropriate admission and care.
Patient education is crucial. Nurses must teach expectant mothers the key signs of true labour and when to come to the hospital, which helps reduce anxiety and unnecessary hospital visits for false labour.
Accurate assessment prevents premature interventions for false labour and ensures timely management for true labour, which is critical for both maternal and fetal well-being.

How to Approach the Question

First, carefully read the question to identify that it is asking for the definitive signs of 'true labour'.
Evaluate each option as a complete set of three signs.
Recall the key characteristics that distinguish true labour from false labour and premonitory signs.
The most critical sign of true labour is progressive change in the cervix, specifically dilatation.
Analyze Option A: It includes painful contractions, show, and cervical dilatation. This combination represents the classic triad of true labour.
Analyze the other options: Option B includes effacement ('taking up'), which can precede labour. Option C includes 'lightening', a pre-labour sign. Option D includes 'rupture of membranes', which can occur without labour.

Concept Tested & Keywords

Q85VplnT1b1b_MZMc45gj1

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 3-8

E6 Obstetrics Williams p. 23-41