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Year Three - Reproductive System > Failure to Progress in Labour > Flashcards

Failure to Progress in Labour Flashcards

1
Q

What does a failure to progress mean during labour?

A

This refers to when labour is not developing at a satisfactory rate

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2
Q

What women are more likely to experience a failure to progress - multiparous or nulliparous?

A

Nulliparous women

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3
Q

What indicates suboptimal progress during the first stage of labour - in nulliparous women?

A

A cervical dilatation less than 0.5cm per hour

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4
Q

What indicates suboptimal progress during the first stage of labour - in multiparous women?

A

A cervical dilatation less than 1cm per hour

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5
Q

What indicates suboptimal progress during the second stage of labour - in nulliparous women?

A

A second stage lasting longer than two hours

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6
Q

What indicates suboptimal progress during the second stage of labour - in multiparous women?

A

A second stage lasting longer than one hour

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7
Q

What indicates suboptimal progress during the third stage of labour - active management?

A

A third stage with active management lasting longer than thirty minutes

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8
Q

What indicates suboptimal progress during the third stage of labour - physiological management?

A

A third stage with physiological management lasting longer than sixty minutes

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9
Q

How do we monitor the progress of labour?

A

Partogram

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10
Q

What is a partogram?

A

This is a graph in which the dilatation of the cervix and the descent of the fetal head is plotted against the duration of labour

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11
Q

How do we measure the dilation of the cervix for a partogram?

A

Four hourly vaginal examination

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12
Q

How do we measure the descent of the fetal head for a partogram?

A

The fetal head is measured in relation to the ischial spines

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13
Q

How does a partogram indicate failure to progress?

A

The readings will cross either to the right of an alert or action line

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14
Q

How do we manage labour when the alert line is crossed in a partogram?

A

This indicates that an amniotomy and a repeat examination in two hours should be conducted

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15
Q

How do we manage labour when the action line is crossed in a partogram?

A

This indicates that care needs to be escalated to obstetric-led care and senior decision makers for appropriate action

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16
Q

What three P’s influence the progress of labour?

A

Power

Passenger

Passage

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17
Q

What does power refer to in labour?

A

The strength of uterine contractions

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18
Q

How does power result in a failure to progress? Why?

A

When there are weak uterine contractions, labour may fail to progress

This is due to the fact that the fetal head will not descend and exert force on the cervix, resulting in no dilatation of the cervix.

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19
Q

How do we manage a failure to progress due to power?

A

We can administer a dose of synthetic IV oxytocin, which will increase the strength and duration of uterine contractions

20
Q

What does passenger refer to in labour?

A

The size, presentation, lie and altitude of the baby

21
Q

How does the size of the baby result in a failure to progress? Why?

A

Macrosomia will make delivery more difficult

There may be issues, such as shoulder dystocia

22
Q

How does the presentation of the baby result in a failure to progress?

A

If the baby presents in a longitudinal lie (breech presentation) or transverse lie

23
Q

What is the preferred position of the baby? Describe this

A

Longitudinal Lie (Cephalic Presentation)

This is when the fetus is positioned straight up and down with its head at the pelvis

24
Q

Describe a longitudinal lie (breech presentation). How do we manage this fetal presentation?

A

This is is when the fetus is positioned straight up and down with its bottom/legs at the pelvis

Woman are offered a c-section due to the associated risks of vaginal delivery.

25
Q

Describe a transverse lie. How do we manage this fetal presentation?

A

This is when the fetus is positioned straight side to side

Woman are offered a c-section

26
Q

What is the preferred position of the fetal head? Describe this

A

Occipito-anterior position

This is when the occiput of the baby’s head is positioned anterior to the pubic symphysis of the mother

This means that the baby is facing down towards the floor

27
Q

How does the position of the baby result in a failure to progress?

A

If the position of the baby is occipito-posterio or occipito-transverse

28
Q

Describe the occipito-posterior position. How does this result in a failure to progress?

A

This is when the occiput of the baby’s head is positioned posterior to the pubic symphysis of the mother.

This means that the baby is facing up towards the ceiling.

This position can cause a relative CPD

29
Q

Describe the occipito-transverse position. How does this result in a failure to progress?

A

This is when the occiput of the baby’s head is positioned transversely to the pubic symphysis of the mother

This position can cause a relative CPD

30
Q

How do we determine the position of the fetal head?

A

We conduct a vaginal examination where we palpate for the anterior and posterior fontanelle

31
Q

What is the shape of the anterior fontanelle?

A

Diamond

32
Q

What is the shape of the posterior fontanelle?

A

Triangular

33
Q

What does passage refer to in labour?

A

It refers to the shape and size of the pelvis and surrounding soft tissues

34
Q

How does passage result in a failure to progress?

A

When the structure of the pelvis is abnormal or there are pelvic obstructions

35
Q

What passage abnormality is commonly associated with labour progression failure?

A

Cephalopelvic disproportion

36
Q

What is cephalopelvic disproportion?

A

This is a condition in which the fetal head is in the correct position for labour however there is a size mismatch between the mother’s pelvis and the fetus’ head

The baby’s head is either proportionally too large, or the mother’s pelvis is too small

37
Q

What are the two clinical signs of cephalopelvic disproportion?

A

Caput

Moulding

38
Q

What is caput?

A

It is defined as diffuse swelling of the scalp caused by the pressure of the scalp against the dilating cervix during labour

39
Q

What is moulding?

A

It is defined as the movement of fetal bone heads closer together or overlap to help the head fit through the pelvis.

The parietal bones overlap occipital and frontal bones

40
Q

What are the five management options of labour progression failure?

A

Oxytocin Infusion

Vaginal Prostaglandin E2

Amniotomy

Instrumental Delivery

Caesarean Section

41
Q

What is the function of oxytocin?

A

It is used to stimulate uterine contractions during labour

42
Q

How do we infuse oxytocin during labour?

A

It is started at a low rate and titrated up at intervals of at least thirty minutes as required

The aim is for four to five contractions per ten minutes

43
Q

What is amniotomy? How does is result in labour progression?

A

The membranes are ruptured artificially using an instrument called an amniohook

This process releases prostaglandins

44
Q

What is instrumental delivery?

A

It involves the use of forceps or a ventouse suction cup to deliver the baby

45
Q

What three requirements are needed for instrumental delivery?

A

Fetal distress is suspected in the second stage of labour (fully dilated cervix)

AND

The woman has received adequate pain relief

AND

The baby is in an adequate position

46
Q

What is a c-section?

A

It involves a surgical operation to deliver the baby via an incision in the abdomen and uterus

Year Three - Reproductive System (52 decks)

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