Managing Complications in Pregnancy and Childbirth: - IAWG

Unsatisfactory progress of labourS-67OBSTRUCTIONNote: Rupture of an unscarred uterus is usually caused by obstructedlabour.• If the fetus is alive, the cervix is fully dilated and the head is at 0station or below, deliver by vacuum extraction (page P-27);• If there is an indication for vacuum extraction and symphysiotomyfor relative obstruction and the fetal head is at -2 station:- Deliver by vacuum extraction (page P-27) and symphysiotomy(page P-53);- If the operator is not proficient in symphysiotomy, deliver bycaesarean section (page P-43).• If the fetus is alive but the cervix is not fully dilated or if the fetalhead is too high for vacuum extraction, deliver by caesareansection (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).INADEQUATE UTERINE ACTIVITYIf contractions are inefficient and cephalopelvic disproportion andobstruction have been excluded, the most probable cause of prolongedlabour is inadequate uterine activity.Inefficient contractions are less common in a multigravida thanin a primigravida. Hence, every effort should be made to rule outdisproportion in a multigravida before augmenting with oxytocin.• Rupture the membranes with an amniotic hook or a Kocher clampand augment labour using oxytocin (page P-17).• Reassess progress by vaginal examination 2 hours after a goodcontraction pattern with strong contractions has been established:- If there is no progress between examinations, deliver bycaesarean section (page P-43);