Failure to Progress in Labour Flashcards
What does a failure to progress mean during labour?
This refers to when labour is not developing at a satisfactory rate
What women are more likely to experience a failure to progress - multiparous or nulliparous?
Nulliparous women
What indicates suboptimal progress during the first stage of labour - in nulliparous women?
A cervical dilatation less than 0.5cm per hour
What indicates suboptimal progress during the first stage of labour - in multiparous women?
A cervical dilatation less than 1cm per hour
What indicates suboptimal progress during the second stage of labour - in nulliparous women?
A second stage lasting longer than two hours
What indicates suboptimal progress during the second stage of labour - in multiparous women?
A second stage lasting longer than one hour
What indicates suboptimal progress during the third stage of labour - active management?
A third stage with active management lasting longer than thirty minutes
What indicates suboptimal progress during the third stage of labour - physiological management?
A third stage with physiological management lasting longer than sixty minutes
How do we monitor the progress of labour?
Partogram
What is a partogram?
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
How do we measure the dilation of the cervix for a partogram?
Four hourly vaginal examination
How do we measure the descent of the fetal head for a partogram?
The fetal head is measured in relation to the ischial spines
How does a partogram indicate failure to progress?
The readings will cross either to the right of an alert or action line
How do we manage labour when the alert line is crossed in a partogram?
This indicates that an amniotomy and a repeat examination in two hours should be conducted
How do we manage labour when the action line is crossed in a partogram?
This indicates that care needs to be escalated to obstetric-led care and senior decision makers for appropriate action
What three P’s influence the progress of labour?
Power
Passenger
Passage
What does power refer to in labour?
The strength of uterine contractions
How does power result in a failure to progress? Why?
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.
How do we manage a failure to progress due to power?
We can administer a dose of synthetic IV oxytocin, which will increase the strength and duration of uterine contractions
What does passenger refer to in labour?
The size, presentation, lie and altitude of the baby
How does the size of the baby result in a failure to progress? Why?
Macrosomia will make delivery more difficult
There may be issues, such as shoulder dystocia
How does the presentation of the baby result in a failure to progress?
If the baby presents in a longitudinal lie (breech presentation) or transverse lie
What is the preferred position of the baby? Describe this
Longitudinal Lie (Cephalic Presentation)
This is when the fetus is positioned straight up and down with its head at the pelvis
Describe a longitudinal lie (breech presentation). How do we manage this fetal presentation?
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.
Describe a transverse lie. How do we manage this fetal presentation?
This is when the fetus is positioned straight side to side
Woman are offered a c-section
What is the preferred position of the fetal head? Describe this
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
How does the position of the baby result in a failure to progress?
If the position of the baby is occipito-posterio or occipito-transverse
Describe the occipito-posterior position. How does this result in a failure to progress?
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
Describe the occipito-transverse position. How does this result in a failure to progress?
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
How do we determine the position of the fetal head?
We conduct a vaginal examination where we palpate for the anterior and posterior fontanelle
What is the shape of the anterior fontanelle?
Diamond
What is the shape of the posterior fontanelle?
Triangular
What does passage refer to in labour?
It refers to the shape and size of the pelvis and surrounding soft tissues
How does passage result in a failure to progress?
When the structure of the pelvis is abnormal or there are pelvic obstructions
What passage abnormality is commonly associated with labour progression failure?
Cephalopelvic disproportion
What is cephalopelvic disproportion?
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
What are the two clinical signs of cephalopelvic disproportion?
Caput
Moulding
What is caput?
It is defined as diffuse swelling of the scalp caused by the pressure of the scalp against the dilating cervix during labour
What is moulding?
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
What are the five management options of labour progression failure?
Oxytocin Infusion
Vaginal Prostaglandin E2
Amniotomy
Instrumental Delivery
Caesarean Section
What is the function of oxytocin?
It is used to stimulate uterine contractions during labour
How do we infuse oxytocin during labour?
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
What is amniotomy? How does is result in labour progression?
The membranes are ruptured artificially using an instrument called an amniohook
This process releases prostaglandins
What is instrumental delivery?
It involves the use of forceps or a ventouse suction cup to deliver the baby
What three requirements are needed for instrumental delivery?
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
What is a c-section?
It involves a surgical operation to deliver the baby via an incision in the abdomen and uterus
