False Labor (Braxton Hicks Contractions)
A 23-year-old primigravida at 36 weeks of gestation reports mild lower abdominal tightening every 20 to 30 minutes for 6 hours. Cardiotocography shows a baseline of 140 beats/min with accelerations, moderate variability and no decelerations. Contractions are irregular and mild. The cervix is closed, long and uneffaced, and the membranes are intact. Which of the following is the most appropriate management?
- A.Induction of labor with vaginal prostaglandin
- B.Reassurance and discharge with fetal movement adviceCorrect
- C.Augmentation of labor with intravenous oxytocin
- D.Immediate delivery by emergency cesarean section
Explanation
This woman has irregular, mild, non-progressive contractions with a closed uneffaced cervix at 36 weeks, which defines false labor (Braxton Hicks contractions) rather than true preterm labor. True labor requires regular painful contractions producing progressive cervical effacement and dilation. The cardiotocograph is normal: baseline 110 to 160 beats/min, moderate variability of 6 to 25 beats/min, present accelerations and absent decelerations, all of which indicate an oxygenated, non-acidemic fetus. When both mother and fetus are well and the cervix is unchanged, the correct management is reassurance, advice on fetal movement counting, and instructions to return for regular painful contractions, bleeding, fluid leakage or reduced movements. Induction or augmentation at 36 weeks would create iatrogenic late preterm birth with its attendant risks of respiratory morbidity, feeding difficulty and neonatal unit admission. Cesarean section has no indication whatsoever in the absence of fetal compromise or obstetric emergency. Distinguishing false from true labor at the bedside rests on serial cervical assessment over 1 to 2 hours rather than on contraction perception alone. The general practitioner's task in this scenario is to avoid unnecessary intervention while safety-netting appropriately.
Why each option
- A.
- Induction would deliberately deliver a late preterm infant with no maternal or fetal indication. Elective delivery before 39 weeks without indication increases neonatal respiratory morbidity.
- B.
- Correct. Irregular mild contractions with an unchanged closed cervix and a normal cardiotocograph indicate false labor; reassurance with safety-netting advice is appropriate.
- C.
- Augmentation is only used when labor has been established but progress is inadequate. This woman is not in labor, and stimulating contractions preterm is harmful.
- D.
- Cesarean section is reserved for maternal or fetal indications such as non-reassuring fetal status, malpresentation in labor or obstructed labor, none of which is present.
Reference: Williams Obstetrics, 26th ed., 2022, Chapter on Normal Labor
This is one of 3,306 questions in the MedBoardSA SMLE bank, with timed test mode, tutor mode, and progress tracking by topic.
Practise the full bank