Assessing progress of labour

Question 1

1st stage - progress (2)

Answer 1

Failure to progress suspected if:

1.

Question 2

2nd stage - progress (3)

Answer 2

1. Passive stage - usually 1hr or less
2. Active stage (pushing) - max 2h nulliparous and 1h multiparous
3. Extend time limit for active stage by 1h if epidural

Question 3

1st stage poor progress - causes (PPP)

Answer 3

1. Power = inefficient uterine activity
2. Passenger = malpositions, malpresentation or large baby
3. Passage = inadequate pelvis

Or a combination of two or more of the above

Question 4

1st stage poor progress - assessment

Answer 4

1. Review hx
2. Abdo palp + frequency and duration of contractions
3. Review fetal condition - FHR, colour/quantity of amniotic fluid
4. Review maternal condition - including hydration and analgesia
5. Vaginal assessment (5) - cervical effacement, dilatation, caput, position and station of head

Question 5

1st stage poor progress - mx (3)

Answer 5

1. Amniotomy (ARM) and reassess in 2h (VE)
2. If no improvement, give oxytocin (IV)
   - Review by senior obstetrician for multiparous women before starting oxytocin bc more likely true obstruction if slow progress
3. LUSCS if fetal distress

Question 6

2nd stage poor progress - mx

Answer 6

Nulliparous women

1. Suspect poor progress if delivery not imminent after 1h of active pushing - offer VE; amniotomy recommended
2. If not delivered in 2h - review by obstetrician to consider instrumental delivery or CS

Multiparous women
1. If delivery not imminent after 1h active pushing - review by obstetrician to consider instrumental delivery or CS (suspect malposition or disproportion in 2nd stage delay in multip)

Question 7

3rd stage poor progress - mx

Answer 7

Change planned physiological 3rd stage to active mx if failure to deliver placenta within 1h, or if haemorrhage