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Questions and Answers
Which condition is NOT associated with obstructed labor?
Which condition is NOT associated with obstructed labor?
In cases of obstructed labor, the mother typically appears exhausted and dehydrated.
In cases of obstructed labor, the mother typically appears exhausted and dehydrated.
True
What is the primary management for obstructed labor?
What is the primary management for obstructed labor?
Immediate C-section and resuscitation of the mother.
Bandl's ring is a groove that forms between the upper segment and lower segment of the ______.
Bandl's ring is a groove that forms between the upper segment and lower segment of the ______.
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Match the following complications with their descriptions:
Match the following complications with their descriptions:
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What is indicated by a ballotable head during the Third Leopold Manoeuvre?
What is indicated by a ballotable head during the Third Leopold Manoeuvre?
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The Fourth Leopold Manoeuvre confirms the findings of the Third Leopold Manoeuvre.
The Fourth Leopold Manoeuvre confirms the findings of the Third Leopold Manoeuvre.
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What distance separates the occiput and sinciput in a flexed fetal position?
What distance separates the occiput and sinciput in a flexed fetal position?
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The interpretation of the Fourth Leopold Manoeuvre includes the confirmation of __________ findings.
The interpretation of the Fourth Leopold Manoeuvre includes the confirmation of __________ findings.
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Match the fetal positions with their corresponding indications:
Match the fetal positions with their corresponding indications:
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What does 'ballotable' indicate regarding the fetal head during labor?
What does 'ballotable' indicate regarding the fetal head during labor?
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A non-ballotable head means the fetal head can be easily moved around.
A non-ballotable head means the fetal head can be easily moved around.
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What does a '5a/5 palpable' status signify about the fetal head?
What does a '5a/5 palpable' status signify about the fetal head?
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The classification of a fetal head that has entered the pelvis but is not movable is called __________.
The classification of a fetal head that has entered the pelvis but is not movable is called __________.
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Match the stage of fetal head engagement with its description:
Match the stage of fetal head engagement with its description:
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What is the new WHO recommendation for the minimum rate of cervical dilatation during labor?
What is the new WHO recommendation for the minimum rate of cervical dilatation during labor?
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The new WHO recommendation maintains the alert line and action line in the labor care guide.
The new WHO recommendation maintains the alert line and action line in the labor care guide.
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What is the cervical dilatation rate for multigravida women during the active phase?
What is the cervical dilatation rate for multigravida women during the active phase?
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For primigravida women, the old WHO recommendation for cervical dilatation is ______ cm/hr.
For primigravida women, the old WHO recommendation for cervical dilatation is ______ cm/hr.
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Match the following groups with their correct cervical dilatation rates:
Match the following groups with their correct cervical dilatation rates:
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What is the most common occipitoanterior position during labor?
What is the most common occipitoanterior position during labor?
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The occipito-posterior position can be categorized as a malposition.
The occipito-posterior position can be categorized as a malposition.
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What is the denominator used for identifying breech position?
What is the denominator used for identifying breech position?
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The occiput near the pubic symphysis indicates an _______ position.
The occiput near the pubic symphysis indicates an _______ position.
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Match the following fetal positions with their corresponding denominators:
Match the following fetal positions with their corresponding denominators:
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What is the maximum duration of the second stage of labor for a primigravida with an epidural?
What is the maximum duration of the second stage of labor for a primigravida with an epidural?
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In cases of arrest of descent, 2 hours without descent is considered prolonged for multigravida.
In cases of arrest of descent, 2 hours without descent is considered prolonged for multigravida.
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What is the requisite cervical dilatation for instrumental delivery?
What is the requisite cervical dilatation for instrumental delivery?
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When fetal distress occurs and the cervix is fully dilated, the management option if the fetal station is at or above +2 is a _______.
When fetal distress occurs and the cervix is fully dilated, the management option if the fetal station is at or above +2 is a _______.
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Match the management scenario with the appropriate response:
Match the management scenario with the appropriate response:
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Which condition is associated with Bandl's ring?
Which condition is associated with Bandl's ring?
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The palpable examination for Schroeder's ring is done through the abdomen.
The palpable examination for Schroeder's ring is done through the abdomen.
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What is the primary method to relieve Schroeder's ring?
What is the primary method to relieve Schroeder's ring?
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Bandl's ring is also known as a __________ ring.
Bandl's ring is also known as a __________ ring.
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Match each condition with its description:
Match each condition with its description:
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What is the purpose of Leopold's manoeuvres?
What is the purpose of Leopold's manoeuvres?
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The first Leopold manoeuvre involves palpating the maternal back to find the fetal parts.
The first Leopold manoeuvre involves palpating the maternal back to find the fetal parts.
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What is assessed during the second Leopold manoeuvre?
What is assessed during the second Leopold manoeuvre?
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If the fetal part felt during the first Leopold is rounded, firm, globular, and ballotable, it is likely the ______.
If the fetal part felt during the first Leopold is rounded, firm, globular, and ballotable, it is likely the ______.
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Match the fetal positions with their descriptions:
Match the fetal positions with their descriptions:
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Which of the following is NOT a cause of prolonged latent phase?
Which of the following is NOT a cause of prolonged latent phase?
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A prolonged latent phase lasting 20 hours in primigravida is considered normal.
A prolonged latent phase lasting 20 hours in primigravida is considered normal.
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What is the best management for a prolonged latent stage of labor?
What is the best management for a prolonged latent stage of labor?
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The active phase of labor begins at _____ cm according to the new WHO guidelines.
The active phase of labor begins at _____ cm according to the new WHO guidelines.
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Match the following phases of labor with their corresponding cervix dilatation for primigravida:
Match the following phases of labor with their corresponding cervix dilatation for primigravida:
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What is the diagnosis confirmed after 22 hours of no descent of the fetal head in a primigravida?
What is the diagnosis confirmed after 22 hours of no descent of the fetal head in a primigravida?
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A low Fetal Heart Rate (FHR) tracing indicates fetal distress and requires immediate Cesarean section.
A low Fetal Heart Rate (FHR) tracing indicates fetal distress and requires immediate Cesarean section.
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What is the minimum cervical dilation observed in this case?
What is the minimum cervical dilation observed in this case?
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In this case, the amniotic fluid showed __________ noted in it.
In this case, the amniotic fluid showed __________ noted in it.
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Match the parameters with their corresponding values:
Match the parameters with their corresponding values:
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What would be a likely course of action if no cervical dilation occurs for 3 hours?
What would be a likely course of action if no cervical dilation occurs for 3 hours?
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Meconium presence in the amniotic fluid indicates normal fetal condition.
Meconium presence in the amniotic fluid indicates normal fetal condition.
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What does '3+ moulding' refer to in the context of labor?
What does '3+ moulding' refer to in the context of labor?
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Study Notes
Obstructed Labour
- A condition where the baby can't be delivered despite good uterine contractions and a fully dilated cervix due to an obstruction in the passage.
- Common causes include transverse lie and conjoint twins.
- Mothers often appear exhausted and dehydrated.
- P/A examination reveals tachypnea and acidotic breathing.
- A Bandl's ring, which is a groove between the upper and lower uterine segments, is visible on a diagram.
Complications
- Uterine rupture
- Vesicovaginal fistula (VVF):
- Occurs 7-10 days after labour due to ischemic injury of the bladder.
- Characterized by constant dribbling of urine.
- The most common cause of VVF in developing countries.
Management
- Immediate C-section followed by maternal resuscitation.
- Avoid waiting, oxytocin, and instrumental delivery.
Active Phase
-
Dilatation of Cervix:
- Primigravida: 1.2 cm/hr
- Multigravida: 1.5 cm/hr
-
Descent of Fetal Head:
- Primigravida: 1 cm/hr
- Multigravida: 2 cm/hr
Protracted Active Phase
- Criteria: Cervical dilatation less than 1 cm/hr.
Second Stage of Labour
- Main Event: Delivery of the baby.
- Epidural anesthesia can prolong this stage by 1 hour.
-
Average Duration:
- Primigravida: 3 hours (without epidural) or 4 hours (with epidural)
- Multigravida: 2 hours (without epidural) or 3 hours (with epidural)
- Arrest of Descent: No descent of the fetal head for 2 hours in primigravida or 1 hour in multigravida.
Management of Prolonged Second Stage
-
Scenario 1: Fetal distress in the second stage with a fully dilated cervix (10 cm).
- Station above +2: C-section.
- Station at +2 or below: Forceps.
-
Scenario 2: Bandl's ring with prolonged second stage.
- C-section is performed. No instrumental delivery.
-
Scenario 3: Cephalopelvic disproportion (CPD) present with prolonged second stage, moulding, and caput.
- Station above +2: C-section.
- Station at +2 or below: Forceps or vacuum.
-
Scenario 4: Prolonged second stage with normal fetal heart rate and no CPD or obstructed labour.
- Station above +2: C-section.
- Station at +2 or below: Forceps or vacuum.
Requisites for Instrumental Delivery
- Full cervical dilatation.
- Station ≥ +2.
- Forceps are preferred over vacuum in cases of fetal distress.
Fetal Position
- Relationship of the denominator to the maternal pelvis.
-
Most Common Positions:
- Antenatal: LOT > LOA.
- During labour: LOT.
- Active labour: DOA.
- Most common occipitoanterior position: LOA.
- Most common occipitoposterior position: ROP.
- Normal vaginal delivery: Positions 1 to 5.
- Occipito-posterior delivery: Positions 6 to 8.
- Breech: Denominator: Sacrum. Position: Left Sacro-anterior.
Face Presentation
- Denominator: Mentum.
- Position: Left Mento-anterior (during labour).
Identifying Fetal Position
- Identify the occiput: Near the posterior fontanelle.
- Based on the position of the occiput:
- Near the pubic symphysis (PS): Occipito-anterior.
- Near the sacral promontory (SP): Occipito-posterior.
- Midway between PS & SP: Occipito-transverse.
- If the occiput is directed to the examiner's right: mother's left, and vice versa.
Bandl's Ring
- AKA: Retraction Ring
- Cause: Obstructed labour
- Site: Between upper and lower uterine segments
- Stage of labour: Second
- Palpable: P/A
- Visible: Not visible
- Maternal & fetal condition: Maternal & fetal distress
- Relieved by: C-section
Schroeder's Ring
- AKA: Construction Ring
- Cause: Spasm of a segment of uterus due to inadvertent use of oxytocin
- Site: First or second stage
- Palpable: P/V
- Visible: Not visible
- Maternal & fetal condition: Normal
- How to relieve: Cessation of oxytocin, uterine relaxants (Terbutaline), if no relaxation: C-section.
WHO Recommendations
At time of admission:
-
Recommended:
- Note vital signs.
- Perform Leopold manoeuvres.
- Auscultate for fetal heart sounds.
- P/V examination (C/1 in active bleeding).
-
Not Recommended: Routine enema, routine pelvic examination, routine CTG, routine pelvic shaving.
In the first stage of labour:
- Ambulation: Allowed in early labor.
-
Oral Intake:
- Solids: Not allowed.
- Liquids: Allowed (Stop 2 hours before surgery).
- Lies in lateral position: Allowed in late labour/membranes ruptured (Stop 6 hours before surgery).
- Bladder function: Encouraged to relieve every hour.
Leopold's Manoeuvres
- Purpose: To determine the position and presentation of a fetus during pregnancy.
Steps Before the Manoeuvre
- Introduce yourself to the mother and explain the procedure.
- Empty the mother's bladder
- Position the mother supine with knees slightly flexed.
- Ensure the mother is adequately exposed.
- Warm your hands.
- Position yourself on the right side of the patient.
Procedure
-
First Leopold: Palpating the fundal height, looking for fetal parts.
- If felt: Longitudinal lie.
- If not felt: Transverse lie.
- Soft, broad, irregular & not independently ballotable (movable): Buttocks.
- Rounded, firm, globular, ballotable: Head.
-
Second Leopold: Examine the umbilical/lateral area for the fetal part.
- Smooth, continuous, rigid area: Back.
- Multiple, irregular, Knob-like structures: Limbs.
Interpretation
- **Lie of the fetus:** Longitudinal or transverse.
- **Presentation:** Cephalic or breech (buttocks or head first).
- **Position:** Determined by which side of the fetus is on the maternal left or right.
Stages of Labour
First Stage of Labour
-
Latent Phase:
- Ends at dilatation of:
- ACOG: 5 cm
- New WHO: 4 cm
- Old WHO: 3 cm
- Ends at dilatation of:
-
Active Phase:
- Begins at dilatation of:
- ACOG: 6 cm
- New WHO: 5 cm
- Old WHO: 4 cm
- Begins at dilatation of:
| Event | Primigravida | Multigravida |
|---|---|---|
| Duration in hours | 12 hours | 8 hours |
| Effacement + dilatation of cervix | 4 hours | 3 hours |
Prolonged Latent Phase
- Latent phase lasting ≥20 hours in primigravida or ≥14 hours in multigravida
- Causes: Unripe cervix, occipito-posterior position, false labour pains.
- Management: Prostaglandins (PGE1 & PGE2), wait for spontaneous delivery, therapeutic rest.
Partogram
- A graphic record of the progress of labor.
- The modified WHO partogram (based on old WHO recommendations) begins at 4 cm dilatation.
- The WHO labour care guide 2020 (based on new recommendations) begins at 5 cm dilatation.
Fetal Position: An Example
- Position 1: Left Occipito Transverse
- Position 2: Left Occipito Anterior
- Position 3: Occipito Anterior
- Position 4: Right Occipito Anterior
- Position 5: Right Occipito Transverse
- Position 6: Right Occipito Posterior
- Position 7: Occipito Posterior
- Position 8: Left Occipito Posterior
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Description
Test your understanding of obstructed labour, including its causes, complications, and management strategies. This quiz covers important details such as dilatation rates and approaches to dealing with this obstetric emergency.
