History of the present labor

1. Contractions. The frequency, duration, onset, and intensity of uterine contractions should be determined. Contractions may be accompanied by a ''bloody show" (passage of blood-tinged mucus from the dilating cervical os). Braxton Hicks contractions are often felt by patients during the last weeks of pregnancy. They are usually irregular, mild, and do not cause cervical change.

2. Rupture of membranes. Leakage of fluid may occur alone or in conjunction with uterine contractions. The patient may report a large gush of fluid or increased moisture. The color of the liquid should be determine, including the presence of blood or meconium.

3. Vaginal bleeding should be assessed. Spotting or blood-tinged mucus is common in normal labor. Heavy vaginal bleeding may be a sign of placental abruption.

4. Fetal movement. A progressive decrease in fetal movement from baseline, should prompt an assessment of fetal well-being with a nonstress test or biophysical profile.

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