3.2 - Variation in uterine activity

Question 1

Define the terms related to abnormal uterine activity

Question 2

Explain factors and processes that lead to patterns of abnormal uterine action

Question 3

Outline midwifery management of patterns of abnormal uterine action.

Question 4

Describe the midwife role in identifying and managing excessive uterine activity including rationale.

Question 5

The six P’s

Answer 5

• passage,
• passenger
• power
• position
• psyche
• perception
• parity - 7th P

Question 6

Uterine Tachsystole

Answer 6

Tachysystole is a uterien contraction rate of more tan 5:10 active labour contractions within 10 minutes
without fetal heart rate abnormalitiies

Question 7

Uterine Hypertonus

Answer 7

Uterine hyperonus is contractions lasting longer than 2 minutes
or
occurring within 60 seconds of each other
without fetal heart rate abnormalities

Question 8

Uterine hyperstimualtion

Answer 8

Uterine huperstimulation is tachysystole or uterine hypertonus with fetal heart rate abnormalities

Question 9

Types of abnormal labour

Answer 9

Poor progress in the first stage (ie up to 10cm dilatation)
Prolonged second stage (after full diliatiation to delivery of the fetus)
Precipitate labour

Primip - 1/2cm dilatation each hour
Multi - 1 cm per hour
second stage primip - 2 hours
multi - 1 hour
third stage
primip -
Multi -

Question 10

Labour - first stage management of delay

Answer 10

https://www.kemh.health.wa.gov.au/~/media/HSPs/NMHS/Hospitals/WNHS/Documents/Clinical-guidelines/Obs-Gyn-Guidelines/Labour-First-stage-Management-of-delay.pdf?thn=0

Question 11

Delay in latent phase of labour

Answer 11

Less than 4cm diliated and 12 hours after commencement of labour
(with painful contractions causeing cervical effacement and dilatation)

Question 12

Delay in active phase

Answer 12

• in established labour
• Painful, regular uterine contractions
• progressive cervical dilatation from 4cm

Question 13

Diagnosis of delay of active phase

Answer 13

Consider:
* cervical dilatation of < 2cm in 4 hours (primp or multi) and/or slowing of prgress (for multipara labour)
* limited progress in descent and rotation of the head
* Changes: reduced strength, duration and frequency of contractions

Question 14

delay in active phase - Nullipara

Answer 14

• Commence oxytocin infusion (if no contraindications - malpresentation, severe moulding, or significant fetal compromise)
• See fetal monitoring guidelines re: commencings CTG
• Repeat VE 4 hours after commencing oxytocin infusion
• if <2 cm progress in 4 hours:
• Reveiw by midwife in charge or registrar - consider caesarean
• if >2cm progress
• VE in 4/24

Question 15

delay in active phase - Multipara

Answer 15

• Full assessment by medical team including abdo palp and VE
• Oxytocin infusion (approval of consultant obstetrician
• fetal monitoriing
• if oxytocin infusion used
• consider IUPT if external CTG monitoring ineffective
• repeat VE in 2 hours after commencement of infusion
• if no oxytocin and birth not immediately indicated repeat VE in 2 hours

If <2cm in hours progress in 2 hours (or not fully dilated)
Discuss with consultant

Question 16

Delay in second phase of labour

Answer 16

https://www.kemh.health.wa.gov.au/~/media/HSPs/NMHS/Hospitals/WNHS/Documents/Clinical-guidelines/Obs-Gyn-Guidelines/Labour-Second-Stage-Management-of-Delay.pdf?thn=0

Question 17

Delay in second phase of labour - primp

Answer 17

One hour

Question 18

Delay in second phase of labour - multi

Answer 18

30 minutes

Question 19

Abnormal labour

Answer 19

• poor progression to 10cm dilatation
• Prolonged second stage
• precipitate labour