Failure to Progress in Labour

Question 1

What does a failure to progress mean during labour?

Answer 1

This refers to when labour is not developing at a satisfactory rate

Question 2

What women are more likely to experience a failure to progress - multiparous or nulliparous?

Answer 2

Nulliparous women

Question 3

What indicates suboptimal progress during the first stage of labour - in nulliparous women?

Answer 3

A cervical dilatation less than 0.5cm per hour

Question 4

What indicates suboptimal progress during the first stage of labour - in multiparous women?

Answer 4

A cervical dilatation less than 1cm per hour

Question 5

What indicates suboptimal progress during the second stage of labour - in nulliparous women?

Answer 5

A second stage lasting longer than two hours

Question 6

What indicates suboptimal progress during the second stage of labour - in multiparous women?

Answer 6

A second stage lasting longer than one hour

Question 7

What indicates suboptimal progress during the third stage of labour - active management?

Answer 7

A third stage with active management lasting longer than thirty minutes

Question 8

What indicates suboptimal progress during the third stage of labour - physiological management?

Answer 8

A third stage with physiological management lasting longer than sixty minutes

Question 9

How do we monitor the progress of labour?

Answer 9

Partogram

Question 10

What is a partogram?

Answer 10

This is a graph in which the dilatation of the cervix and the descent of the fetal head is plotted against the duration of labour

Question 11

How do we measure the dilation of the cervix for a partogram?

Answer 11

Four hourly vaginal examination

Question 12

How do we measure the descent of the fetal head for a partogram?

Answer 12

The fetal head is measured in relation to the ischial spines

Question 13

How does a partogram indicate failure to progress?

Answer 13

The readings will cross either to the right of an alert or action line

Question 14

How do we manage labour when the alert line is crossed in a partogram?

Answer 14

This indicates that an amniotomy and a repeat examination in two hours should be conducted

Question 15

How do we manage labour when the action line is crossed in a partogram?

Answer 15

This indicates that care needs to be escalated to obstetric-led care and senior decision makers for appropriate action

Question 16

What three P’s influence the progress of labour?

Answer 16

Power

Passenger

Passage

Question 17

What does power refer to in labour?

Answer 17

The strength of uterine contractions

Question 18

How does power result in a failure to progress? Why?

Answer 18

When there are weak uterine contractions, labour may fail to progress

This is due to the fact that the fetal head will not descend and exert force on the cervix, resulting in no dilatation of the cervix.

Question 19

How do we manage a failure to progress due to power?

Answer 19

We can administer a dose of synthetic IV oxytocin, which will increase the strength and duration of uterine contractions

Question 20

What does passenger refer to in labour?

Answer 20

The size, presentation, lie and altitude of the baby

Question 21

How does the size of the baby result in a failure to progress? Why?

Answer 21

Macrosomia will make delivery more difficult

There may be issues, such as shoulder dystocia

Question 22

How does the presentation of the baby result in a failure to progress?

Answer 22

If the baby presents in a longitudinal lie (breech presentation) or transverse lie

Question 23

What is the preferred position of the baby? Describe this

Answer 23

Longitudinal Lie (Cephalic Presentation)

This is when the fetus is positioned straight up and down with its head at the pelvis

Question 24

Describe a longitudinal lie (breech presentation). How do we manage this fetal presentation?

Answer 24

This is is when the fetus is positioned straight up and down with its bottom/legs at the pelvis

Woman are offered a c-section due to the associated risks of vaginal delivery.

Question 25

Describe a transverse lie. How do we manage this fetal presentation?

Answer 25

This is when the fetus is positioned straight side to side Woman are offered a c-section

Question 26

What is the preferred position of the fetal head? Describe this

Answer 26

Occipito-anterior position This is when the occiput of the baby’s head is positioned anterior to the pubic symphysis of the mother This means that the baby is facing down towards the floor

Question 27

How does the position of the baby result in a failure to progress?

Answer 27

If the position of the baby is occipito-posterio or occipito-transverse

Question 28

Describe the occipito-posterior position. How does this result in a failure to progress?

Answer 28

This is when the occiput of the baby’s head is positioned posterior to the pubic symphysis of the mother. This means that the baby is facing up towards the ceiling. This position can cause a relative CPD

Question 29

Describe the occipito-transverse position. How does this result in a failure to progress?

Answer 29

This is when the occiput of the baby’s head is positioned transversely to the pubic symphysis of the mother This position can cause a relative CPD

Question 30

How do we determine the position of the fetal head?

Answer 30

We conduct a vaginal examination where we palpate for the anterior and posterior fontanelle

Question 31

What is the shape of the anterior fontanelle?

Answer 31

Diamond

Question 32

What is the shape of the posterior fontanelle?

Answer 32

Triangular

Question 33

What does passage refer to in labour?

Answer 33

It refers to the shape and size of the pelvis and surrounding soft tissues

Question 34

How does passage result in a failure to progress?

Answer 34

When the structure of the pelvis is abnormal or there are pelvic obstructions

Question 35

What passage abnormality is commonly associated with labour progression failure?

Answer 35

Cephalopelvic disproportion

Question 36

What is cephalopelvic disproportion?

Answer 36

This is a condition in which the fetal head is in the correct position for labour however there is a size mismatch between the mother’s pelvis and the fetus’ head The baby’s head is either proportionally too large, or the mother’s pelvis is too small

Question 37

What are the two clinical signs of cephalopelvic disproportion?

Answer 37

Caput Moulding

Question 38

What is caput?

Answer 38

It is defined as diffuse swelling of the scalp caused by the pressure of the scalp against the dilating cervix during labour

Question 39

What is moulding?

Answer 39

It is defined as the movement of fetal bone heads closer together or overlap to help the head fit through the pelvis. The parietal bones overlap occipital and frontal bones

Question 40

What are the five management options of labour progression failure?

Answer 40

Oxytocin Infusion Vaginal Prostaglandin E2 Amniotomy Instrumental Delivery Caesarean Section

Question 41

What is the function of oxytocin?

Answer 41

It is used to stimulate uterine contractions during labour

Question 42

How do we infuse oxytocin during labour?

Answer 42

It is started at a low rate and titrated up at intervals of at least thirty minutes as required The aim is for four to five contractions per ten minutes

Question 43

What is amniotomy? How does is result in labour progression?

Answer 43

The membranes are ruptured artificially using an instrument called an amniohook This process releases prostaglandins

Question 44

What is instrumental delivery?

Answer 44

It involves the use of forceps or a ventouse suction cup to deliver the baby

Question 45

What three requirements are needed for instrumental delivery?

Answer 45

Fetal distress is suspected in the second stage of labour (fully dilated cervix) AND The woman has received adequate pain relief AND The baby is in an adequate position

Question 46

What is a c-section?

Answer 46

It involves a surgical operation to deliver the baby via an incision in the abdomen and uterus