Failure of labour to progress despite good uterine contractions

Causes

• Any failure of descent of the baby down the birth canal

• Large baby

• Small or deformed pelvis

• Malpresentation - the presenting part of the foetus is not the head, eg. breech presentation, arm

• Malposition - an abnormal position of the foetal head when this is the presenting part, eg. occipito-posterior

Clinical features

• Contractions are strong but no evidence of descent of the presenting part

• Malposition or malpresentation may be felt on abdominal examination

• In late stages, the pains may stop when the uterus is ruptured, or in a first delivery they will just stop spontaneously

Management
HC2

Set up an IV drip, see p354

Start 5-day course of antibiotics: amoxicillin 500mg every 8 hours or erythromycin 500mg every 6 hours

plus metronidazole 400mg every 8 hours

Refer urgently to HC4 for further management

Prevention

• Careful monitoring of labour using a partogram