Prolonged Labour

Question 1

How should a delay in the first stage of labour be managed if membranes are in tact?

Answer 1

Artificial rupture of membranes and repeat vaginal exam 2 hours later

Question 2

How can a delay in the first stage of labour be managed if the membranes aren’t intact?

Answer 2

Oxytocin - will increase strength of contractions

Question 3

If oxytocin is offered to induce 1st stage of labour, what else should be offered?

Answer 3

Epidural
CTG monitoring
Vaginal exam - 4 hours later

Question 4

How would you diagnose a delay in 1st stage of labour?

Answer 4

Consider:
Dilation <2cm in 4 hrs
Descent and rotation of head
Strength, duration and frequency of contractions

Question 5

What dilation would you expect on vaginal exam 4 hours after offering oxytocin for delayed 1st stage of labour?

Answer 5

> 2cm - continue 4hr vaginal exam

<2cm - obstetrician review for ?C-Section

Question 6

How can a delay in the 2nd stage of labour be managed?

Answer 6

Oxytocin (+epidural and CTG)

Instrumental or C-Section

Question 7

When would you diagnose a delay in the 2nd stage of labour?

Answer 7

> 2hr if nulliparous

>1hr if multiparous

Question 8

What should be offered women who have inadequate rotation and descent in active 2nd stage labour?

Answer 8

Vaginal exam

Amniotomy if membranes intact

Question 9

When should vaginal exam and amniotomy be offered in active 2nd stage of labour?

Answer 9

Nulliparous >1hr

Multiparous >30 mins

Question 10

If delay is diagnosed in 2nd stage labour, what should be done?

Answer 10

Refer to someone who can perform operative vaginal birth

Obstetrician review for oxytocin use

Question 11

What is important to know about the use of oxytocin in labour?

Answer 11

Increase frequency and strength of contractions

Require CTG monitoring

Epidural should be offered

Dose should be increased until contractions are 4 in 10mins. Give 30mins between up titrations