Prolonged Labour

Question 1

Two definitions of prolonged labour

Answer 1

1. Cervical dilitation <0.5cm/hr in the active phase
2. Secondary arrest: cervical dilitation ceases over 2-3hrs following previously normal progress

Question 2

What is the most common cause of slow progress in labour

Answer 2

Incoordinate uterine activity (contractions that vary in frequency and/or intensity)

In primigravidae is often associated with OP position of the head

Question 3

Treatment of prolonged labour

Answer 3

• Treat dehydration if present
• Effective pain relief (usually epidural anaesthesia)
• Oxytocin augmentation is often neccessary
  
  • If this is done, but 2-4 hrs later progress has not occured or if relative or true cephalopelvic disproportion is present : C-section

Question 4

What do you give for augmentation in labour, and what do you need to be wary of

Answer 4

10units syntocinon in 500mL electrolyte solution

**beware of primaparous patients as there could be disproportion and therefore obstructed labour, and giving this could cause uterine rupture

Question 5

Occipitoposterior Position?

Answer 5

The most common malposition of the the fetal head, fetal spine aligned with maternal spine.

• Some degree of deflexion is presentsuch that the presenting diameter is greater then the suboccipito bregmatic (>9.5cm)
• The fetal limbs are easily palpatable
• Slow onset of labour + back pain

Question 6

For a baby in an occipitoposterior position what are the four outcomes

Answer 6

• Long internal rotation: Occiput eventually rotates anteriorally, but over time and labour is prolonged
• Spontaneous occiptioposterior delivery: in a spacious pelvis, inc risk of perineal tearing
• Persistant occipitoposterior position: rotation does not occur, descent is poor. Operative delivery is often required
• Deep Transverse arrest: deflexed head lodges. operative delivery is often neccessary.

Delivery by c-section is neccessary if the head stays above the ischial spiens