9.6 Failure to Progress Flashcards
What are the 4 Ps that influence progress of labour?
Power - uterine contractions
Passenger - size, presentation and position of baby
Passage - shape and size of the pelvis and soft tissues
Psyche can be a 4th - support and antenatal preparation for labour
What counts as delay in the first stage of labour?
- less than 2cm cervical dilatation in 4 hours
- slowing of progress in multiparous women
What is used to monitor progress during the first stage?
a partogram
What is recorded on a partogram?
- cervical dilatation (4 hourly VE)
- descent of the fetal head in relation to ischial spines
- maternal HR, BP, t, urine out
- fetal HR
- freq. contractions in 10 mins
- status of membranes, liquor and mec/blood stain
- drugs and fluids in
What lines are on a partogram that indicate progress of labour?
“alert line”
“action line”
What happens when the alert or action lines are crossed in a partogram?
“alert line” crossed = ARM and then VE in 2hrs
“action line crossed” = escalate to obstetric led care
What does success in the second stage of labour depend on?
the 4 Ps
Power - uterine contractions
Passenger - size, presentation and position of baby. (size, attitude, lie, presentation)
Passage - shape and size of the pelvis and soft tissues
Psyche can be a 4th - support and antenatal preparation for labour
What time counts as a delay in the second stage of labour?
2 hours for nulliparous women
1 hour for multiparous women
What types of breech presentations can there be?
complete breech - hips and knees are flexed (cannonball jump in pool)
frank breech - hips are flexed, knees extended (bottom first)
footling breech - foot hanging through cervix
What time counts as a delay in the third stage of labour?
more than 30 mins with active management (IM oxytocin and cord traction)
more than 60 mins with physiological management
What are you main options to manage failure to progress?
- ARM
- oxytocin infusion
- instrumental delivery
- c-section
