prolonged labour

Question 1

how do we assess progress of labour ?

Answer 1

frequency of uterine contractions
abdominal palpation
vaginal examination
partogram

Question 2

why might labour become prolonged ?

Answer 2

three Ps
Power
Passenger
Passage

Question 3

what can be done in an effort to increase power and maintain effecient uterine contractions ?

Answer 3

cervical ripening by PGs
Amniotomy
Oxytocin (syntocinon)

Question 4

what are the side effects of prostaglandins ?

Answer 4

GI upset
fever
palpitations

Question 5

if power is efficient but there is still no progress in labour what must be considered?

Answer 5

think of a mechanical cause involving the passage and/or the passage
more syntocinon will not help

Question 6

in cases of true obstructed labour what is the best step in management ?

Answer 6

Caesarian delivery

Question 7

what are the possible problems involving the passenger that could result in obstructed labour ?

Answer 7

macrosomia
malpresentation
malposition
number ( locked twins)

Question 8

what are the possible problems involving the passage that could result in an obstructed labour ?

Answer 8

contracted pelvis
cervical dystocia
soft tissue obstructing (e.g: fibroid)

Question 9

what are the complications of obstructed or arrested labour ?

Answer 9

1. female genital tract injuries :
   e.g rupture uterus
   perineal lacerations
   2.maternal exhaustion and dehydration
2. puerperal sepsis
3. postpartum hge
4. fetal distress
5. traumatic birth injuries

Question 10

what are the complications of CS on the fetus ?

Answer 10

Transient tachypnea

iatrogenic prematurity

Question 11

what are the long term complications of CS?

Answer 11

CS scar niche
Rupture uterus in subsequent pregnancies
placenta praevia + placenta accreta
Adhesions

Question 12

what are the two surgical approaches for CS ?

Answer 12

lower segment CS ( LSCS)

lower vertical incision

Question 13

what is the main difference between the two surgical approaches in CS ?

Answer 13

LSCS - woman can deliver vaginally after this, scar is stronger and healing is better
Lower vertical - must only deliver only CS in subsequent pregnancies

Question 14

in preterm deliveries which surgical approach do we opt for in CS ?

Answer 14

lower vertical incision

Question 15

what method of delivery is recommended in twins ?

Answer 15

if the first twin is cephalic patient should be counseled for VD

Question 16

when should a vaginal birth after delivery be offered (VBAC/TOLAC) ?

Answer 16

1. if there has been one or two previous transverse CS scar (LSCS)
2. no other uterine scars
3. no history of uterine rupture
4. availability of anesthesia and personnel for emergency CS

Question 17

what is precipitate labour ?

Answer 17

labour in less than 4 hours from onset of labour pains to expulsion of fetus

Question 18

what are the risk factors for precipitate labour ?

Answer 18

multiparous with patulous BC
cervical incompetence
uncontrolled IOL ( induction of labour)
Small baby