Failure to progress in labour

Question 1

Causes

Answer 1

Powers: Inefficient uterine action, maternal exhaustion
Passenger: Occipito-posterior position, brow or face presentation
Passage: Cephalo-pelvic disproportion

Question 2

Management - 1st stage

Answer 2

Consider mobilisation if delay not extreme and mother willing
If nulliparous: artificial ROM, start oxytocin if no further dilatation 2h later
If multiparous: artificial ROM, start oxytocin 2h later if no malposition
Both: LSCS if no increase in rate of dilatation within 4h of oxytocin

Question 3

Management - 2nd stage

Answer 3

If nulliparous: Anticipate if head high/epidural present. Start oxytocin and delay pushing by 1h
If multiparous: No oxytocin, anticipate malposition or presentation
Both: Push for 1h, then instrumental delivery if prerequisites met, LSCS if not