Prolonged labour

Question 1

What are the 3(/4) Ps that must be considered when assessing the progress of labour?

Answer 1

1. Power = uterine contractions
2. Passenger = foetal position and size
3. Passage = parity and maternal pelvis
   (4. Psyche = mother’s mental wellbeing - cortisol and adrenaline have inhibiting effects on oxytocin)

Question 2

How is a diagnosis of delay made in the 1st stage of labour?

Answer 2

-Primigravida = cervical dilatation of <2cm in 4h
-Multigravida = cervical dilatation of <2cm in 4h OR a slowing of progress

Question 3

How is slow progress in the 1st stage of labour managed?

Answer 3

1. ARM (if not already ruptured)
2. Syntocinon
3. C-section

Question 4

What information is presented on the partogram?

Answer 4

-Foetal HR
-Cervical dilatation
-Frequency and strength of contractions
-Liquor colour
-Maternal obs
-Any syntocinon infusions

Question 5

When is instrumental delivery considered?

Answer 5

MATERNAL
-Slow progress in 2nd stage of labour
-Maternal exhaustion
-To avoid raising BP
FOETAL
-Presumed foetal compromise

Question 6

What complications are there following instrumental delivery?

Answer 6

MATERNAL
-Failure
-Increased blood loss
-Postpartum pain
-Perineal trauma
-Pelvic floor weakness
-Psychological
FOETAL
-Cephalohaematoma
-Facial brusing
-Facial nerve palsy
-Retinal haemorrhage

Question 7

What risks to the mother are there following a C-section?

Answer 7

1. General surgical risks (VTE, bleeding, infection)
2. Postpartum complications (wound infection, PPH, endometritis)
3. Damage to local structures (ureter, bladder, bowel, vessels)
4. Effects on the abdominal organs (hernias, adhesions, ileus)
5. Effects on future pregnancies (increased risk of repeat CS, uterine rupture, placenta praevia, stillbirth)
6. Effects on baby (lacerations, transient tachypnoea)

Question 8

What is the success rate of VBAC and what are the contraindications?

Answer 8

-75% success rate
-Contraindications =
–Previous uterine rupture
–Vertical incision made in CS
–Placenta praevia and other contraindications to vaginal delivery