Obstructed Labour Flashcards
1
Q
Defintion
A
When labour is not developing at a satisfactory rate
2
Q
What classes as a delay?
A
<2cm of dilation in 4 hrs or slow progress in multiparous women
3
Q
3 P’s
A
- POWER (uterine contractions)
- PASSENGER (size, presentation, and position of the baby)
- PASSAGE (the shape and size of the pelvis and soft tissues
4
Q
3 PHASES
A
- Latent phase - 0 to 3cm dilation of the cervix. This progresses at around 0.5% per hour. There are irregular contractions
- Active phase - 3 to 7cm dilation. This progresses at around 1cm per hour, and there are regular contractions.
- Transition phase - 7 to 10cm dilation. This progresses at around 1cm per hour, and there are strong and regular contractions.
5
Q
How is the first stage of labour monitored
A
- Cervical dilatation (measure by a 4-hourly vaginal examination)
- Descent of the fetal head (in relation)
- Maternal pulse, blood pressure, temperature and urine output
- Fetal heart rate
- Frequency of contractions (uterine contractions measure per 10 mins)
- Status of the membranes, presence of liquid and whether the liquid is stained by blood or meconium
- Drugs and fluids that have been given
*alert and action lines -> crossing alert line = amniotomy (ROM)
6
Q
Monitoring second stage
A
from 10cm dilation to delivery
Delays = >2 hours in nulliparous and 1 hour in multiparous
3 P’s:
- Power, if weak uterine contractions = oxytocin infusion
- Passenger:
= Size: can cause shoulder dystocia
= Attitude: posture of baby
= Lie: longitudinal lie, transverse, oblique
= Presentation: cepaglic shoulder, breech cephalic
Passage
7
Q
How is third stage monitoring?
A
- From delivery of abby to delivery of placenta
- Delay = > 30 mins with active management (IM oxytocin) or >60 with physiological management.
8
Q
Management
A
- Amniotomy, also known as artificial rupture of membranes (ARM)
- Oxytocin infusion (aim is 4-5 per 10 times)
- Instrumental delivery
Caesarean section
