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Obstetrics > Failure to Progress > Flashcards

Failure to Progress Flashcards

1
Q

How do make a diagnosis of failure to progress?

A

On a partogram

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2
Q

What are the two types of poor progress?

A
  1. Delayed labour- there is progress of labour but it is below the requirement for normal
  2. Arrested labour -labour progresses normally and then stops
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3
Q

What are the two features of delayed labour/slow progress?

A
  1. Hypoactive uterine contractility

2. Hyperactive uterine contractility

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4
Q

Who is affected the most by delayed progress between primigravida and multigravida?

A
  1. Primigravida
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5
Q

How does hypoactive uterine contractility present?

A
  1. Decreased pain
  2. Decreased basal tone of the myometrium
  3. The contractions are decreased in frequency, the duration is decreased <30seconds and the they are not strong enough (not enough amplitude)
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6
Q

What is the treatment for delayed progress?

A

Oxytocin infusion

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7
Q

How does hyperactive uterine contractility present?

A
  1. Increased pain
  2. The basal myometrium tone is increased or normal
  3. Contractions are strong, irregular and the strength differs with each contraction
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8
Q

Why are the contractions in hyperactive uterine contractility not efficient in pushing the foetus out?

A

They start anywhere and move in any direction

For contractions to be effective they have to start from the fungus and move downwards

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9
Q

What is the primary treatment for hyperactive uterine contractility?

A
  1. Analgesic
  2. Sedation
  3. Psychological support
  4. Empty the bladder
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10
Q

What is the main reason for arrested labour?

A

There is usually an obstruction at the pelvic floor obstructing the baby from going out
-the head is too big or the pelvis is too tight

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11
Q

What are the causes delayed labour/slow progress?

A
  1. Cephalo-pelvic disproportion
  2. Malpresentation (especially occipito-posterior)
  3. Excessive sedation
  4. Excessive stretching (polyhydroamnios, multiple pregnancies, large baby)
  5. Cervical pathology
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12
Q

What are the causes of arrested labour?

A
  1. Cephalo-pelvic disproportion
  2. Malpresentation or abnormal lie
  3. Pelvic tumor (myoma or ovarian tumour)
  4. In primigravida-tight perineum
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13
Q

When looking on partogram if the patient reaches the action line, what is the next step?

A

Refer or if in a level 2 hospital then we can observe the mom for 4 hours instead of 2 hours

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14
Q

What is the management of poor progress of labour in the latent phase?

A

If the membranes are intact and the fetal heart normal then we do nothing

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15
Q

What is the management of poor progress of labour in the active phase?

A
  1. Observe poor progress if cervical is <1cm per hour
  2. Apply rule of P’s to find cause
  3. Allow 2 hours for observations-check for uterine contractions and ensure they are 3 per 10 minutes
  4. After 2 hours assess whether there’s no progress, delayed progress or normal progress
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16
Q

What do we do if there’s no progress after 2 hours of assessing the patient?

A

We then do a c/s

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17
Q

What do we do if there is normal progress of more than >2cm per hour?

A

NVD

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18
Q

What are the 4 P’s?

A
  1. Patient(mother)
  2. Power
  3. Passenger(fetus)
  4. Passage(pelvis)
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19
Q

What is under patient?

A
  1. Pain
  2. Dehydration
  3. Full bladder
  4. Emotional anxiety
  5. Patients position in the bed
20
Q

What is under Power?

A
  1. Inadequate contractions- <40 seconds <2 every 10 minutes
  2. Ineffective contractions
    - primigravida
21
Q

What is under passenger?

A
  1. Fetal size(if >4kg with 2+/3+ moulding means there might cephalo-pelvic disproportion)
  2. Fetal lie(transverse/oblique)
  3. Fetal presentation and position (eg. Breech)
  4. Fetal heart rate
  5. Level of presenting part (head not engaged 2/5 or less)
22
Q

What is under under passage?

A
  1. Cervix
  2. Membranes(membranes not ruptured)
  3. Application
  4. Presenting part
  5. Pelvic size and shape
23
Q

What is the management of poor progress in the second stage of labour?

A
  1. Determine the level of the fetal head in fifths above the symphysis pubis
  2. Wait 30 minutes and observe uterine contractions and fetal heart rate
  3. Do another vaginal exam and do another palpation
  4. There will be 3 possibilities
    - no progress then do c/s
    - wait another 30 minutes to curb doubt
    - progress of at least, if 1/5 then do NVD
24
Q

When do we do ventouse or forceps delivery?

A
  1. It must be in theatre then do c/s
25
Q

Is true cephalo-pelvic disproportion an indication for c/s?

A

Yes

26
Q

What are the absolute signs for cephalo-pelvic disproportion?

A
  1. Obviously small pelvis with poor progress
  2. Excessive capital and moulding of fetal head with poor progress of labour
  3. Arrest of progress in the presence of normal contractions
  4. Overriding of fetal head over symphysis pubis
27
Q

What are the relative signs for cephalo-pelvic disproportion?

A
  1. Moderate capital and moulding
  2. Cervical oedema
  3. Poor application of the fetal head on the cervix
28
Q

What is caput succedaneum?

A

It is symmetrical swelling of the fetal scalp. Over the lowest point of the head during labour

29
Q

When does caput succedaneum disappear?

A

It disappears after 2 days after delivery

30
Q

How does caput succedaneum feel?

A
  1. It is oedema to us and firm on palpation
31
Q

How does caput succadeneum present that is different from cephalohematoma?

A

Cephalohematoma is softer than caput and ballotable

It also does not cross suture lines

32
Q

If moulding is extreme what can it cause

?

A

A skull fracture

33
Q

In regards to moulding which bone is pushed under the parietal bones?

A

The occipital bone

34
Q

What are the maternal complications of prolonged labour?

A
  1. Maternal exhaustion and dehydration and ketoacidosis
  2. Fistula formation-vesico-vaginal and rectovaginal
  3. Maternal death
  4. Postpartum haemorrhage
  5. Prolapse, incontinence
35
Q

What are the fetal complications of prolonged labour?

A
  1. Foetal distress
  2. Foetal death
  3. Respiratory distress-meconium aspiration
  4. Cerebral palsy
  5. Foetal death
36
Q

What is the association of infection and the poor progress of labour?

A

The more prolonged the labour is, the more chance of infection

37
Q

What should we always think of if the baby is in the vertex position and there is meconium in the amniotic fluid?

A

Fetal hypoxia because it is always abnormal

38
Q

What does fresh meconium in the amniotic fluid look like?

A

It is green and thick

39
Q

What does old meconium in the amniotic fluid look like?

A

It is yellow and thin

40
Q

What is amnio-infusion?

A

It is when we insert saline in the amniotic fluid to dilute the meconium

41
Q

How do we manage meconium in the amniotic fluid?

A
  1. Clear the airways

2. Monitor fetal heart rate

42
Q

What is the half life and action time of Oxycotin?

A

Half-life is 3-4 minutes

Action time is 20 minutes

43
Q

Where is oxytocin produced naturally?

A

It is produced in the hypothalamus and secreted by the posterior pituitary in a pulsation way

44
Q

What stimulates the secretion of oxytocin?

A
  1. Nipple stimulation
  2. Cervix stretching
  3. Labour causing uterine contractions
45
Q

What are the uses oxytocin?

A
  1. Helps in milk production

2. Helps with uterine atony and prevents post-partum haemorrhage

Obstetrics (18 decks)

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