9.6 Failure to Progress

Question 1

What are the 4 Ps that influence progress of labour?

Answer 1

Power - uterine contractions

Passenger - size, presentation and position of baby

Passage - shape and size of the pelvis and soft tissues

Psyche can be a 4th - support and antenatal preparation for labour

Question 2

What counts as delay in the first stage of labour?

Answer 2

• less than 2cm cervical dilatation in 4 hours

- slowing of progress in multiparous women

Question 3

What is used to monitor progress during the first stage?

Answer 3

a partogram

Question 4

What is recorded on a partogram?

Answer 4

• cervical dilatation (4 hourly VE)
• descent of the fetal head in relation to ischial spines
• maternal HR, BP, t, urine out
• fetal HR
• freq. contractions in 10 mins
• status of membranes, liquor and mec/blood stain
• drugs and fluids in

Question 5

What lines are on a partogram that indicate progress of labour?

Answer 5

“alert line”

“action line”

Question 6

What happens when the alert or action lines are crossed in a partogram?

Answer 6

“alert line” crossed = ARM and then VE in 2hrs

“action line crossed” = escalate to obstetric led care

Question 7

What does success in the second stage of labour depend on?

Answer 7

the 4 Ps

Power - uterine contractions

Passenger - size, presentation and position of baby. (size, attitude, lie, presentation)

Passage - shape and size of the pelvis and soft tissues

Psyche can be a 4th - support and antenatal preparation for labour

Question 8

What time counts as a delay in the second stage of labour?

Answer 8

2 hours for nulliparous women

1 hour for multiparous women

Question 9

What types of breech presentations can there be?

Answer 9

complete breech - hips and knees are flexed (cannonball jump in pool)

frank breech - hips are flexed, knees extended (bottom first)

footling breech - foot hanging through cervix

Question 10

What time counts as a delay in the third stage of labour?

Answer 10

more than 30 mins with active management (IM oxytocin and cord traction)

more than 60 mins with physiological management

Question 11

What are you main options to manage failure to progress?

Answer 11

• ARM
• oxytocin infusion
• instrumental delivery
• c-section