Obs: L&D - Failure to progress Flashcards
what is failure to progress and who is it most likely in?
when labour is not developing at a satisfactory rate
more likely to occur in women in labour for the first time
progress in labour is influenced by 3 P’s, what are they?
- Power - uterine contractions
- Passenger - size, presentation and position of the baby
- Passage - the shape and size of the pelvis and soft tissues
(Psyche can be added as the fourth - referring to support and antenatal preparation for L&D)
what are the 3 phases of the first stage of labour?
latent phase - 0-3cm - progresses 0.5cm per hour with irregular contractions
active phase - 3-7cm - progresses1cm per hour with regular contractions
transition phase - 7-10cm - progresses at 1cm per hour with strong and regular contractions
when is there considered to be delay in the first stage of labour?
less than 2 com of cervical dilatation in 4 hour
slowing of progress in multiparous women
how are women in the first stage of labour monitored?
using a partogram which record:
- Cervical dilatation (measured by a 4-hourly vaginal examination)
- Descent of the fetal head (in relation to the ischial spines)
- Maternal pulse, blood pressure, temperature and urine output
- Fetal heart rate
- Frequency of contractions
- Status of the membranes, presence of liquor and whether the liquor is stained by blood or meconium
- Drugs and fluids that have been given
crossing alert line is an indication for amniotomy
crossing action like means escalation to obstetric-led care
how are uterine contractions measured?
contractions per 10 minutes
describe the alert and action line
dilation of cervix ix plotted against duration of labour
when it takes to long the readings will cross the lines
alert line = indication for amniotomy & repeat exam in 2 hours
action line = escalation to obstetric-led care
what is the second stage of labour and what is considered to be delay in the second stage?
10cm dilation to delivery of the baby
delay = >1 hour in multiparous women, >2 hours in nulliparous women
from the 3 Ps, what does power refer to?
strength of the uterine contraction
(when weak, oxytocin can be used to stimulate uterus)
from the 3 Ps, what does passenger refer to?
size - size of baby (large = harder to deliver)
attitude = posture of the fetus, how its back is rounded, how head and limbs are flexed
lie - longitudinal, transverse, oblique
presentation - cephalic, shoulder, breech
what are the different breech presentations?
Complete breech – with hips and knees flexed (like doing a cannonball jump into a pool)
Frank breech – with hips flexed and knees extended, bottom first
Footling breech – with a foot hanging through the cervix
from the 3 Ps, what does passage mean?
size and shape of the passageway - mainly the pelvis
when there is delay in the second stage, what interventions can be made?
- Changing positions
- Encouragement
- Analgesia
- Oxytocin
- Episiotomy
- Instrumental delivery
- Caesarean section
what is the third stage of labour and when is there considered to be delay?
from delivery of the baby to delivery of the placenta
delay = > 30 mins with active management, >60 with physiological management
what is active management of the third stage of labour and how is it carried out?
IM oxytocin and controlled cord traction
IM oxytocin given
abdomen palpated to assess for uterine contraction for delivery of placenta and traction applied to cord. at same time hand presses uterus up to prevent uterine prolapse
