Poor Progress in Labour

Question 1

How can abnormal progress of labour be defined According to the Friedman’s curve ?

Answer 1

1- minimal change in cervical dilatation or effacement during a 2-hour period (for each of the phase: (latent and active phase) in a woman having regular uterine contractions before the beginning of 2nd stage of labour
2- as a descent of ≤1 cm/h in nullipara and ≤2 cm/h in multipara during the second stage of labour

Question 2

What are the changes in the active phase of labour in modern women compared with what observed by Dr Friedman ?

Answer 2

mothers do not rapidly start dilating at 3 cm as was observed by Dr Friedman
Instead most modern women (both nullipara and multipara) begin active labour when they are 6cm dilated

Question 3

What are the Diagnostic criteria for abnormal labour ?

Answer 3

Indicator
Nullipara
Multipara
*Prolonged latent phase. > 20 h. > 14 h
*Prolonged second stage > 2 h. > 1h
without (with) epidural
. > 3h. > 2h

Question 4

What is the average of the second stage?

Answer 4

Nullipara 50 minutes
Multipara. 20 minutes

Question 5

What are the Protraction disorders of labour?

Answer 5

1- Protracted active phase dilation Nullipara<1.2 cm/h multipara
<1.5 cm/h
2- Protracted descent
Nullipara ≤1 cm/h
multipara ≤2 cm/h

Question 6

What are the Arrest disorders of labour?

Answer 6

1- Prolonged deceleration. Nullipara > 3h Multipara > 1h
2- Secondary arrest of dilation Nullipara > 2h Multipara > 2h
3- Arrest of descent
Nullipara > 1h Multipara > 1h
4- Failure of descent
No descent in the deceleration phase or the second stage of labour

Question 7

What is the definition of Prolonged third stage
?

Answer 7

> 30 minutes

Question 8

What is the definition of Adequate contractions in the active phase of labour?

Answer 8

> 200 Montevideo units per 10 minutes

Question 9

What is the new definition of the “ Arrest of first stage of labour
“ ?

Answer 9

cervical dilatation of 6 cm and with ruptured membranes has no cervical changes for 4 hours or more despite of having adequate contractions or for 6 hours or more of inadequate contractions

Question 10

In case the woman’s cervix has dilated less than 6 cm can Arrest of first stage of labour be diagnosed?

Answer 10

No , she requires additional time and interventions before arrest of labour can be diagnosed

Question 11

What is the new definition of” Arrest of second stage of labour” ?

Answer 11

there is no descent or rotation of the baby:
• After ≥4 hours in nulliparous women with an epidural ( previously 3h)
• After ≥3 hours in nulliparous women without an epidural( previously 2h)
• After ≥3 hours in multiparous women with an epidural( previously 2h)
• After ≥2 hours in multiparous women without an epidural( previously 1h)

Question 12

What are the causes for abnormal progress of labour ?

Answer 12

Triple P
passage (bony pelvis and the soft tissues )
passenger (baby)
power (expulsive uterine contractions)

Question 13

Is Deformities of bony pelvis a common cause for abnormal progress of labour?

Answer 13

No rare cause

Question 14

What are the pelvic types ?

Answer 14

android, gynaecoid, platypelloid, and anthropoid

Question 15

What is the role of amniotomy in the management of standard labour?

Answer 15

not recommended to be used routinely as part of standard labour management and care
is not associated with a significant reduction in the duration of first stage

Question 16

How can Patients with prolonged latent phase be managed ?

Answer 16

1- Optimisation of maternal wellbeing
2- Amniotomy
3- Mobilisation during labour
4- Stimulation with oxytocin

Question 17

What are the recommendations of NICE for the use of oxytocin to stimulate labour?

Answer 17

is encouraged for nulliparous
should only be started in multiparous women once the obstetrician has made full assessment
( risk of uterine rupture)

Question 18

What is the recommendations about the use of syntocinon in the second stage?

Answer 18

It not recommend , whether or not the regional anaesthesia is in place.
🌸The only exception : poor contractions at the beginning of second stage in nulliparous with regional anaesthesia.

Question 19

In cases of uterine hypocontractility , what is the dose of oxytocin?

Answer 19

(30 units diluted in 500 mL of saline) must be started at a rate of 0.5–1.0 mU/min and gradually increased by 1–2 mU/ min at every 20–30 minutes, until an adequate pattern of contractions is achieved

Question 20

How much time oxytocin takes to reach the steady state levels following IV administration ?

Answer 20

30 - 45 minutes

Question 21

What is the pattern of contractions Oxytocin should be titrated to provide ?

Answer 21

4–5 per 10 minutes with each contraction lasting for approximately 40 seconds

Question 22

after augmentation with oxytocin, when CS is indicated?

Answer 22

1- no response after 3 h.
2- less than 2 cm progress after 4 h

Question 23

How to monitor mother & baby with the use of oxytocin?

Answer 23

1- Continuous foetal monitoring
2- vaginal examination must be done every 4-h

Question 24

What are the best position for the woman during first & second stage to reduce the duration of labour ?

Answer 24

🌸 first stage:walking and upright positions
🌸 Second stage: Not lying down in supine position / not being in lithotomy position

Question 25

How much time Maternal pushing can be delayed in the second stage?

Answer 25

at least 1 hour after full dilatation unless the woman has the urge to push or the head is on the perineum

Question 26

What is The most common causes for abnormal hardness and tenderness of the uterus in labour?

Answer 26

abruptio placentae or a ruptured uterus.

Question 27

Is continuous electronic monitoring better than Intermittent auscultation for the assessment of foetal well-being during labour?

Answer 27

found to be equivalent

Question 28

What is the time limitations vof the 2nd stage of labour?

Answer 28

Regardless of parity, delivery should be accomplished preferably within 4 hours of full dilatation

Question 29

What is the most common cause of primary dysfunctional labour ?

Answer 29

🎁 In nulliparous : inadequate uterine activity
🎁in multiparous : CPD