FAILURE TO PROGRESS IN LABOUR

on 26.6.06 with 0 comments



Failure of the cervix to dilate and for the presenting part to descend is a common event but it
is important to appreciate that it is a clinical observation and not a diagnosis.

CAUSES OF FAILURE TO PROGRESS IN LABOUR
  1. Incorrect diagnosis. Patient not in labour.
  2. Dysfunctional uterine activity. Common in primigravidae, rare in multiparae. Associated with occipito-posterior malposition.
  3. Malposition/malpresentation.
  4. Cephalopelvic disproportion.
  5. Rare causes e.g. cervical stenosis from previous cervical surgery or pelvic tumour such as fibroid or ovarian cyst.


Dysfunctional Labour

  • Dysfunctional labour occurs when the cervix does not dilate despite the presence of uterinecontractions.The cervix should dilate at a rate of between 1 and 2 centimetres per hour inthe active phase. Progress is more rapid in parous women and dysfunctional labour is muchcommoner in primigravidae.
  • Treatment consists of escalating doses of oxytocin. This should only be used in parous women when there is no evidence of malpresentation and even then only with caution.The dose of oxytocin should be titrated against the quality and frequency of uterine contractions
Malposition/Malpresentation
  • Malposition means incorrect positioning of the vertex.This includes occipito-posterior (OP) positions and deflection of the head short of brow presentation.








Malpresentation means the presence of any presenting part other than the vertex — face, brow, breech, shoulder, compound presentation.





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Category: Obstetrics Notes

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