Failure to Progress

Question 1

Failure to progress

Answer 1

When labour is not developing at a satisfactory rate

Question 2

Who is more likely to have failure to progress

Answer 2

First labour

Question 3

What influences labour

Answer 3

Power (uterine contractions)

Passenger (size, presentation and position of the baby)

Passage (the shape and size of the pelvis and soft tissues)

Question 4

Delay in the first stage of labour

Answer 4

Less than 2cm of cervical dilatation in 4 hours

Slowing of progress in a multiparous women

Question 5

Partogram

Answer 5

Monitors progress of the first stage of labour

Question 6

What is recorded on a partogram

Answer 6

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

Question 7

How are uterine contractions measured

Answer 7

Measure in contractions per 10 minutes i.e. 2 in 10 = 2 contraction in 10 minutes

Question 8

Crossing the alert line

Answer 8

Indication for amniotomy (artificially rupturing the membranes)

Repeat examination in 2 hours.

Question 9

Crossing the action line

Answer 9

Care needs to be escalated to obstetric-led care and senior decision-makers for appropriate action

Question 10

Delay of the second stage

Answer 10

When active second stage (pushing) lasts over:

• 2 hours in a nulliparous woman
• 1 hour in a multiparous woman

Question 11

Causes of delayed labour

Answer 11

Power - weak contractions

Passenger - macrosomia

Passage - narrow pelvis

Question 12

Possible interventions for the delayed second stage

Answer 12

Changing positions
Encouragement
Analgesia
Oxytocin - more powerful contractions 
Episiotomy
Instrumental delivery
Caesarean section

Question 13

Delay in the third stage of labour

Answer 13

More than 30 minutes with active management

More than 60 minutes with physiological management

Question 14

Active management of the third stage of labour

Answer 14

IM oxytocin

Controlled cord traction

Question 15

Management of Failure to Progress

Answer 15

Amniotom - artificial rupture of membranes (ARM) for women with intact membranes

Oxytocin infusion

Instrumental delivery

Caesarean section

Question 16

Aim with an oxytocin infusion

Answer 16

4 - 5 contractions per 10 minutes