Failure to progress - 1st stage of labour

Question 1

Dilatation in active phase?

Answer 1

3cm to full 10 cm dilatation

Question 2

How is slow progress in latent phase managed?

Answer 2

Conservatively

Question 3

When is delay first identified?

Answer 3

When progress on partogram falls to the right of ‘Alert line’
Indicates less than 1 cm dilatation per hour

Question 4

When is delay in progress of labour suspected and intervention warranted?

Answer 4

< 2 cm dilation in 4hours

Identified at the 4 hour ‘action line’

Question 5

Causes of poor progress in phase 1

Answer 5

1. Large Baby
2. Small Pelvis
3. Malpresentation
4. Lack of uterine pushing power

Question 6

What are the normal rates of progression in terms of cervical dilation?

Answer 6

Primip - 0.5 - 1 cm/h

Multip - 1 - 2 cm/h

Question 7

How do we manage a patient whose labour is failing to progress due to inefficient contractions?

Answer 7

Artificial rupture of membranes

Use of IV syntocinon - caution must be exercised in multiparous patient

Question 8

How does artificial rupture of membrane help labour along?

Answer 8

Thought to release prostaglandins.

Question 9

Why is it important to monitor fetus after administration of IV syntocinon?

Answer 9

If contractions become too frequent this can reduce oxygen exchange in the placental bed and lead to fetal hypoxia.