Slow progress

Question 1

Maternal risks of slow progress in labour

Answer 1

Infection
Uterine rupture
Genital fistulas
Maternal death

Question 2

Fetal risks of slow progress in labour

Answer 2

Infection
Asphyxia/traumatic injury
Still birth
Neonatal death

Question 3

Assessment of slow progress

Answer 3

• In established labour?
• Evidence of obstruction?
• Likely cause? 3Ps

Question 4

Definition of first stage of labour

Answer 4

Characterised by regular painful uterine contractions, a substantial degree of cervical effacement and more rapid cervical dilatation from 5 cm

Question 5

Average rate of progress in 1st stage of labour?

Answer 5

0. 9cm/hr for P0
1. 2cm/hr for multiparous

Diagnosis of slow progress made in P0 when <2cm progress made over 4 hours

Question 6

Diagnosis of prolonged active 2nd stage?

Answer 6

Nulliparous woman: after 2 hours or when total
length of Second Stage exceeds 3 hours

Multiparous women: after 1 hour

Question 7

Prolonged 3rd stage?

Answer 7

Physiological third stage considered prolonged
after 60 minutes

Active third stage considered prolonged after 30
minutes

Actions: breastfeed, empty bladder / consider
IDC, IV cannulation, uterotonic as treatment