Failure to progress

Question 1

What does failure to progress refer to?

Answer 1

• when labour is not developing at a satisfactory rate
• this increases risk to the fetus and the mother
• more likely to occur in women in labour for the first time compared with those prev given birth

Question 2

What are the three Ps that progress in labour is influenced by?

Answer 2

• power (uterine contractions)
• passenger (size, presentation and position of baby)
• passage (shape and size of pelvis and soft tissue
• psyche can be added as fourth P referring to support and antenatal prep beforehand

Question 3

When is delay in the first stage of labour considered?

Answer 3

when there is:

• <2cm cervical dilatation in 4 hours
• slowing progress in a multiparous women

Question 4

What is used for monitoring women’s progress in first stage of labour?

Answer 4

partogram

Question 5

What is recorded on a partogram?

Answer 5

• Cervical dilatation (measured by a 4-hourly vaginal examination)
• Descent of the fetal head (in relation to the ischial spines)
• Maternal pulse, blood pressure, temperature and urine output
• Fetal heart rate
• Frequency of contractions
• Status of the membranes, presence of liquor and whether the liquor is stained by blood or meconium
• Drugs and fluids that have been given

Question 6

What does the success of the second stage depend on and when is it considered delayed?

Answer 6

• depends on the 3 ps: power, passenger, passage
• delay in second stage is when active stage (pushing) lasts over 2hrs in a nulliparous woman or 1hr in a multiparous woman

Question 7

What does power refer to and what can be done when it’s low?

Answer 7

• power refers to stregnth of uterine contractions

- when weak uterine contractions an oxytocin infusion can be used to stimulate the uterus

Question 8

What does passenger refer to?

Answer 8

-refers to the 4 descriptive qualities of the fetus:
>size (size of baby most importantly the head)
>attitude (posture of the fetus)
>lie (position of fetus in relation to mothers body)
>presentation

Question 9

What are the different types of presentations?

Answer 9

• cephalic -head first
• shoulder presentation - shoulder first
• breech presentation - legs first –> can be complete (with hips and knees flexed), frank (with hips flexed and knees extended, bottom first), or footling (with a foot hanging through the cervix

Question 10

What does passage refer to?

Answer 10

-size and shape of the passageway, mainly the pelvis

Question 11

What interventions may be required when problems occur in the second stage of labour?

Answer 11

• changing positions
• ecouragement
• analgesia
• oxytocin
• episiotomy
• instrumental delivery
• c-section

Question 12

What is delay in the third stage classified as?

Answer 12

• more than 30mins with active management
• more than 60mins with physiological management

Active management involves intramuscular oxytocin and controlled cord traction.

Question 13

What are the management options for failure to progress?

Answer 13

managed by midwives and obstetricians with:

• amniotomy, AROM, for women with intact membranes
• oxytocin infusion
• instrumental delivery
• c-section (if fetal compromise)