Poor Progress in Labour Flashcards
How can abnormal progress of labour be defined According to the Friedman’s curve ?
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
What are the changes in the active phase of labour in modern women compared with what observed by Dr Friedman ?
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
What are the Diagnostic criteria for abnormal labour ?
Indicator
Nullipara
Multipara
*Prolonged latent phase. > 20 h. > 14 h
*Prolonged second stage > 2 h. > 1h
without (with) epidural
. > 3h. > 2h
What is the average of the second stage?
Nullipara 50 minutes
Multipara. 20 minutes
What are the Protraction disorders of labour?
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
What are the Arrest disorders of labour?
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
What is the definition of Prolonged third stage
?
> 30 minutes
What is the definition of Adequate contractions in the active phase of labour?
> 200 Montevideo units per 10 minutes
What is the new definition of the “ Arrest of first stage of labour
“ ?
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
In case the woman’s cervix has dilated less than 6 cm can Arrest of first stage of labour be diagnosed?
No , she requires additional time and interventions before arrest of labour can be diagnosed
What is the new definition of” Arrest of second stage of labour” ?
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)
What are the causes for abnormal progress of labour ?
Triple P
passage (bony pelvis and the soft tissues )
passenger (baby)
power (expulsive uterine contractions)
Is Deformities of bony pelvis a common cause for abnormal progress of labour?
No rare cause
What are the pelvic types ?
android, gynaecoid, platypelloid, and anthropoid
What is the role of amniotomy in the management of standard labour?
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
How can Patients with prolonged latent phase be managed ?
1- Optimisation of maternal wellbeing
2- Amniotomy
3- Mobilisation during labour
4- Stimulation with oxytocin
What are the recommendations of NICE for the use of oxytocin to stimulate labour?
is encouraged for nulliparous
should only be started in multiparous women once the obstetrician has made full assessment
( risk of uterine rupture)
What is the recommendations about the use of syntocinon in the second stage?
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.
In cases of uterine hypocontractility , what is the dose of oxytocin?
(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
How much time oxytocin takes to reach the steady state levels following IV administration ?
30 - 45 minutes
What is the pattern of contractions Oxytocin should be titrated to provide ?
4–5 per 10 minutes with each contraction lasting for approximately 40 seconds
after augmentation with oxytocin, when CS is indicated?
1- no response after 3 h.
2- less than 2 cm progress after 4 h
How to monitor mother & baby with the use of oxytocin?
1- Continuous foetal monitoring
2- vaginal examination must be done every 4-h
What are the best position for the woman during first & second stage to reduce the duration of labour ?
🌸 first stage:walking and upright positions
🌸 Second stage: Not lying down in supine position / not being in lithotomy position
