Failure to progress in labour

Question 1

3 Ps

Answer 1

Power (uterine contractions)
Passenger (size, presentation and position of baby)
Passage (shape and size of pelvis soft tissues)

Question 2

First stage of labour 3 phases

Answer 2

Latenet phase
Active phase
Transition phase

Question 2

First stage of labour 3 phases

Answer 2

Latenet phase
Active phase
Transition phase

Question 3

First stage of labour 3 phases

Answer 3

Latenet phase
Active phase
Transition phase

Question 4

What are the latent phase

Answer 4

0-3cm dilation of cervix. Progresses at around 0.5cm per hour. Irregular contractions

Question 5

What is the active phase?

Answer 5

3cm-7cm dilation of cervix
1cm progression
Regular contractions

Question 6

What is the transition phase of labour

Answer 6

7cm to 10cm dilation cervix
Progresses at around 1cm/hr
Strong and regular contractions

Question 7

When is delay in first stage of labour

Answer 7

<2cm cervical dilatiation in 4 hours
Slowing progress in multiparous women

Question 8

What is recorded on a partogram

Answer 8

Cervical dilatation (measured by 4 hourly vaginal exam)
Descent of foetal head (in relation to ischial spines)
Maternal pulse, BP, temp, urine output
Foetal HR
Status membranes, presence of liquor and whether stained with blood or meconium
Drugs and fluids that have been given

Question 9

How uterine contractions measured

Answer 9

How many contractions in 10 minutes

Question 10

PLots on a partogram

Answer 10

Dilation fo cervix against duration of labour

Question 11

What lines can cross on partogram

Answer 11

alert
actiom

Question 12

What happens when partogram crosses alert lime

Answer 12

Indication fro amniotomy - artificial rupture of membranes and repeat exam in 2 hours

Question 13

Action line crossed in partogram

Answer 13

Escalated to obs led care and senior decision makers

Question 14

What is the second stage of labour

Answer 14

10cm dilatation cervix to delivery

Question 15

When is delay in the second stage of labour?

Answer 15

When active 2nd stage lasts over
2 hours in nulliparous women
1 hour in multiparous women

Question 16

What is used when uterune contractions are weak?

Answer 16

Oxytocin infusion to stimulate the uterus

Question 17

What qualities of the foetus affect delivery?

Answer 17

Size
Attitude
Lie
presenation

Question 18

What is attitude?

Answer 18

How back is rounded and how head and limbs are flexed

Question 19

What is a longitudinal lie?

Answer 19

Foetus straight up and down

Question 20

What is a transverse lie?

Answer 20

Foetus straight side to side

Question 21

What is an oblique lie

Answer 21

Foetus is at an angle

Question 22

Tyoes of presentation

Answer 22

• Cephalic presentation – the head is first
• Shoulder presentation – the shoulder is first
• Breech presentation – the legs are first. This can be:
  o Complete breech – with hips and knees flexed (like doing a cannonball jump into a pool)
  o Frank breech – with hips flexed and knees extended, bottom first
  o Footling breech – with a foot hanging through the cervix

Question 23

Possible interventions when second stage of labour is delayed

Answer 23

Chagning positions
Encouragement
Analgesia
Oxytocin
Episiotomy
Instrumental delivery
Caesarean section

Question 24

what is Delay in thrid stage of labour

Answer 24

More than 30 mins with active management
More than 60 mins physiological management

Question 25

Active management of third stage of labbour

Answer 25

IM oxytocin
Controlled cord traction

Question 26

Managment of failure to progress

Answer 26

• Amniotomy, also known as artificial rupture of membranes (ARM) for women with intact membranes
• Oxytocin infusion
• Instrumental delivery
• Caesarean section

Question 27

How is oxytocin administered

Answer 27

Started at low rate and titrated up at intervals of at least 30 mins as required

Question 27

How is oxytocin administered

Answer 27

Started at low rate and titrated up at intervals of at least 30 mins as required

Question 27

How is oxytocin administered

Answer 27

Started at low rate and titrated up at intervals of at least 30 mins as required

Question 28

What aim is for rate of uterine contractions?

Answer 28

Last 30-45 secs
Become stronger and more painful as labour progresses
2 contractions per 10 minutes (ISH - massively varies)

Question 29

What can too often contractions cause?

Answer 29

Foetal compromise - not enough time for recovery between contractions