Managing Complications in Pregnancy and Childbirth: - IAWG

S-58 Unsatisfactory progress of labour• Presentation other than vertex with occiputanteriorCervix fully dilated and woman has urge to push, butthere is no descent• Malpresentation ormalposition, page S-69Prolonged expulsivephase, page S-67Figure S-6, page S-59 is a sample partograph for prolonged activephase of labour:• The woman was admitted in active labour at 10 AM:- fetal head 5/5 palpable;- cervix dilated 4 cm;- inadequate contractions (two in 10 minutes, each lasting lessthan 20 seconds).• At 2 PM:- fetal head still 5/5 palpable;- cervix dilated 4 cm and to the right of the alert line;- membranes ruptured spontaneously and amniotic fluid is clear;- inadequate uterine contractions (one in 10 minutes, lastingless than 20 seconds).• At 6 PM:- fetal head still 5/5 palpable;- cervix dilated 6 cm;- contractions still inadequate (two in 10 minutes, each lastingless than 20 seconds).• At 9 PM:- fetal heart rate 80 per minute;- amniotic fluid stained with meconium;- no further progress in labour.• Caesarean section was performed at 9:20 PM due to fetal distress.• Note that the partograph was not adequately filled out. Thediagnosis of prolonged labour was evident at 2 PM and labourshould have been augmented with oxytocin at that time.