A 1-4 page document written by a final year medical student with distinction grades in the uploaded modules. These notes are concise and of very high quality - using a combination of textbooks, lectures, and current guidelines (NICE and RCOG). These documents are the only resource you should need f...
Failure to Progress in Labour
AKA Prolonged labour, Labour dystocia
Criteria
Stage 1 actie At least 4 cm dilaton and contractng:
phase Dilaton occurring at a rate of
<1cm/2hr (primip)
<1cm/1hr (multp)
for 2hrs in a row despite frequent and strong contractons
Stage 2 Fully dilated, regular contractons:
Primip – duraton of this stage is >3hours
Multp - duraton of this stage is >2hour
Note: If on Epidural give a “passive hour” i.e. give them an extra 1hr for passive
baby descent before they start pushing
Aetology:
Inadequate “power” (poor uterine contractons, epidural, diabetes, NM disease, maternal exhauston)
Inadequate “passenger” (foetal malpresentaton, macrosomia, hydrocephalus, extreme asynclitsm)
- Relatie CPD ceehaalphelice dcshrphprtpn) = Where foetal positoning prevent vaginal delivery. Vaginal delivery
may be atempted in certain cases but C-secton preferred.
Inadequate “passage” (abnormal bony pelvis)
- Absplute CPD ceehaalphelice dcshrphprtpn) = Disparity between size of bony pelvis and foetal head preclude
vaginal delivery no mater what. C-secton needed.
Risk factors:
Labour inducton
Epidural (↓power)
Maternal exhauston
Oligio/polyhydramnios
Premature rupture of membranes (PROM)
Macrosomia
History of failure to progress in a previous labour
Diabetes
Fertlity treatments
Investgatons
Before management you must confrm whether there is adequate uterine actvity/”power”
- Obseriaton – at least 3 strong contractons per 10 minutes is adequate
- Tonometer (external uterine monitor) – measures muscle tone and tming but not intensity
- Intrauterine pressure catheter (IUPC) – 150-200 Montevideo units is adequate
Management
If power is inadequate Augmentaton
If power is adequate = CPD
- Relatve CPD Assisted deliiery (episiotomy, manual rotaton etc.) or C-secton
- Absolute CPD C-secton
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