Preventing obstructed

Obstructed labourlabour
 Aims

 To understand the use of the

partograph

 Practice using the partograph

 To recognise slow progress in labour

and manage it appropriately
Partograph:

 a graphical record of progress in labour

 Should be used for all deliveries

 Start using once the woman is in labour

 Labour
 A correct diagnosis of labour has to be
made before opening the partograph

 2-3 uterine contractions in 10mins

 Progressive shortening and thinning of the
cervix during labour and
 Cervical dilatation 4cm or more dilated:
open partograph
 Beware of false labour
 Regular pains, but no progressive cervical dilatation
 Consider causes ? UTI, ? BV, ? infection
 ? Prolonged latent phase
 Contractions persist mild-moderate
 At term
 CX less than 3cm
 Membranes intact

 BEWARE strong contractions without progress, check

lie, presentation- act fast- REFER
Modified
WHO
Partograph
Fetal monitoring
Fetal monitoring
LIQOUR MOULDING

I Membranes intact + sutures apposed

C Clear liqour ++ sutured overlapped, reducible

M Meconium stained liqour +++ sutures overlapped, irreducible

B Blood stained liqour

Maternal vital signs
 Progress in labour
 Regular contractions
< 20 sec, 20-40 sec, > 40 sec

 Dilatation of cervix –at least 1cm per hour

(follows alert line)
- chart as X

 Descent of presenting part in fifths

paplable
- chart as O
 ALERT and ACTION lines
• Alert line: A line starts at 4 cm of cervical dilatation to
the point of expected full dilatation at the rate of 1 cm per
hour.
• Moving to the right or the alert line may require referral to
hospital for extra vigilance

• Action line: Parallel and 4 hours to the right of the alert

line. A lag time of 4 hours between a slowing of labour
and the need for intervention.
• When Action line is reached this is the critical line at
which specific management decisions must be made
Progress of Labor
Note that the first plot
on the partograph
starts on the Alert Line
 Between alert and action lines

• At lower level facility, the women must be transferred to

a higher level facility which can do a cesarean section,
unless the cervix is almost fully dilated
• Continue routine observations but prepare for transfer if
needed
• ARM may be performed if membranes are still intact
 At or beyond action line

• Repeat full medical assessment

• Consider intravenous infusion / bladder catheterization /
analgesia
• Options
 Augment with oxytocin by intravenous infusion only if there are
no contraindications
 Refer to a higher level facility
 Deliver by cesarean section if there is fetal distress or
diagnosis is obstructed labour
 x
Slow
progress
x
o o

in labour
 Slow progress in labour ?

Powers
 Inadequate contractions (dysfunctional labour)
Passage
 Pelvis too small for baby (cephalopelvic disproportion
– CPD)
Passenger
 Abnormal presentation or position ( e.g. transverse)
 Fetal abnormality (e.g. hydrocephalus)
 Powers
 Slow progress often due to inadequate uterine
contractions
 Restore normal progress by:
- rupturing membranes
- giving syntocinon by IV infusion where allowed
- consider referral to FRU

 Reassess in 2 hours
 If no further progress REFER for CS
 Passage or Passenger:

 Cephalopelvic disproportion (CPD)

 Malpresentation or Malposition

 Fetal abnormality
 Remember!

 Slow progress may be due to any of the 3Ps

 Augmentation with syntocinon may be

dangerous and cause rupture of uterus
Slow progress in second stage:

 Delay in descent of presenting part

 Delay in expulsion
Slow progress in second
stage: Management
 Review maternal position
 Consider augmentation
 If fetal head >2/5 palpable deliver by CS
(Refer)
 If fetal head < 1/5 palpable assist delivery
by vacuum extraction (if avaliable)
If slow progress becomes no
progress and no action is
taken labour becomes
obstructed.
obstructed
 RECAP
When to start the partograph
Correct diagnosis of labour
 Diagnosis and management of slow
progress in labour
Diagnosis and management of obstructed
labour