Summary Failure to Progress in Labour

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