Managing Complications in Pregnancy and Childbirth: - IAWG

S-66 Unsatisfactory progress of labour- ampicillin 2 g IV every 6 hours;- PLUS gentamicin 5 mg/kg body weight IV every 24 hours;- If the woman delivers vaginally, discontinue antibioticspostpartum;- If the woman has a caesarean section, continue antibioticsPLUS give metronidazole 500 mg IV every 8 hours untilthe woman is fever-free for 48 hours.PROLONGED ACTIVE PHASE• If there are no signs of cephalopelvic disproportion or obstructionand the membranes are intact, rupture the membranes with anamniotic hook or a Kocher clamp (page P-17).• Assess uterine contractions:- If contractions are inefficient (less than three contractions in10 minutes, each lasting less than 40 seconds), suspectinadequate uterine activity (page S-66);- If contractions are efficient (three contractions in 10 minutes,each lasting more than 40 seconds) suspect cephalopelvicdisproportion, obstruction, malposition or malpresentation(see below).• General methods of labour support may improve contractions andaccelerate progress (page C-57).CEPHALOPELVIC DISPROPORTIONCephalopelvic disproportion occurs because the fetus is too large orthe maternal pelvis is too small. If labour persists with cephalopelvicdisproportion, it may become arrested or obstructed. The best test todetermine if a pelvis is adequate is a trial of labour. Clinical pelvimetry isof limited value.• If cephalopelvic disproportion is confirmed (Table S-10, page S-57), deliver by caesarean section (page P-43).• If the fetus is dead:- Deliver by craniotomy (page P-57);- If the operator is not proficient in craniotomy, deliver bycaesarean section (page P-43).