Failure to progress in labour Flashcards
3 Ps
Power (uterine contractions)
Passenger (size, presentation and position of baby)
Passage (shape and size of pelvis soft tissues)
First stage of labour 3 phases
Latenet phase
Active phase
Transition phase
First stage of labour 3 phases
Latenet phase
Active phase
Transition phase
First stage of labour 3 phases
Latenet phase
Active phase
Transition phase
What are the latent phase
0-3cm dilation of cervix. Progresses at around 0.5cm per hour. Irregular contractions
What is the active phase?
3cm-7cm dilation of cervix
1cm progression
Regular contractions
What is the transition phase of labour
7cm to 10cm dilation cervix
Progresses at around 1cm/hr
Strong and regular contractions
When is delay in first stage of labour
<2cm cervical dilatiation in 4 hours
Slowing progress in multiparous women
What is recorded on a partogram
Cervical dilatation (measured by 4 hourly vaginal exam)
Descent of foetal head (in relation to ischial spines)
Maternal pulse, BP, temp, urine output
Foetal HR
Status membranes, presence of liquor and whether stained with blood or meconium
Drugs and fluids that have been given
How uterine contractions measured
How many contractions in 10 minutes
PLots on a partogram
Dilation fo cervix against duration of labour
What lines can cross on partogram
alert
actiom
What happens when partogram crosses alert lime
Indication fro amniotomy - artificial rupture of membranes and repeat exam in 2 hours
Action line crossed in partogram
Escalated to obs led care and senior decision makers
What is the second stage of labour
10cm dilatation cervix to delivery
When is delay in the second stage of labour?
When active 2nd stage lasts over
2 hours in nulliparous women
1 hour in multiparous women
What is used when uterune contractions are weak?
Oxytocin infusion to stimulate the uterus
What qualities of the foetus affect delivery?
Size
Attitude
Lie
presenation
What is attitude?
How back is rounded and how head and limbs are flexed
What is a longitudinal lie?
Foetus straight up and down
What is a transverse lie?
Foetus straight side to side
What is an oblique lie
Foetus is at an angle
Tyoes of presentation
- Cephalic presentation – the head is first
- Shoulder presentation – the shoulder is first
- Breech presentation – the legs are first. This can be:
o Complete breech – with hips and knees flexed (like doing a cannonball jump into a pool)
o Frank breech – with hips flexed and knees extended, bottom first
o Footling breech – with a foot hanging through the cervix
Possible interventions when second stage of labour is delayed
Chagning positions
Encouragement
Analgesia
Oxytocin
Episiotomy
Instrumental delivery
Caesarean section
what is Delay in thrid stage of labour
More than 30 mins with active management
More than 60 mins physiological management
Active management of third stage of labbour
IM oxytocin
Controlled cord traction
Managment of failure to progress
- Amniotomy, also known as artificial rupture of membranes (ARM) for women with intact membranes
- Oxytocin infusion
- Instrumental delivery
- Caesarean section
How is oxytocin administered
Started at low rate and titrated up at intervals of at least 30 mins as required
How is oxytocin administered
Started at low rate and titrated up at intervals of at least 30 mins as required
How is oxytocin administered
Started at low rate and titrated up at intervals of at least 30 mins as required
What aim is for rate of uterine contractions?
Last 30-45 secs
Become stronger and more painful as labour progresses
2 contractions per 10 minutes (ISH - massively varies)
What can too often contractions cause?
Foetal compromise - not enough time for recovery between contractions
