Failure to progress

Question 1

How do you define failure to progress in the 1st stage of labour in a nulliparous and multiparous woman?

Answer 1

Nulliparous - Failure to dilate by > 2cm in 4 hours

Multiparous - Slowing of progress

Question 2

How do you define failure to progress in the 2nd stage of labour in a nulliparous and multiparous woman?

Answer 2

Nulliparous - Failure to deliver by 2 hours

Multiparous - Failure to deliver by 1 hour

Question 3

3 causes for failure to progress?

Answer 3

Powers - inefficient uterine action (i.e primagravida,
Passengers - malpresentation, macrosomia, fetal anomalies
Passage - Cephalopelvic disproprtion, pelvis not suitable

Question 4

You are the senior on the labour ward, and there is a woman at 37 weeks gestation who is in the 2nd stage of labour and has been pushing for 2 hours now to no avail. She has previously given birth to 2 healthy boys. Current baby is haemodynamically stable, station 0, 0/5 palpable with an occpitoanterior presentation. You are asked to examine her, what is your next course of action?

A. Prescribe oxytocin
B. Watch and wait
C. Instrumental delivery
D. Caesarean section
E.  Take fetal blood

Answer 4

C. Instrumental delivery