Managing Complications in Pregnancy and Childbirth: - IAWG

S-68 Unsatisfactory progress of labour- If progress continues, continue oxytocin infusion and reexamineafter 2 hours. Continue to follow progress carefully.PROLONGED EXPULSIVE PHASEMaternal expulsive efforts increase fetal risk by reducing the delivery ofoxygen to the placenta. Allow spontaneous maternal “pushing”, but donot encourage prolonged effort and holding the breath.• If malpresentation and obvious obstruction have been excluded,augment labour with oxytocin (page P-25).• If there is no descent after augmentation:- If the head is not more than 1/5 above the symphysis pubis orthe leading bony edge of the fetal head is at 0 station, deliverby vacuum extraction (page P-27) or forceps (page P-33);- If the head is between 1/5 and 3/5 above the symphysis pubisor the leading bony edge of the fetal head is between 0 stationand -2 station:- Deliver by vacuum extraction (page P-27) andsymphysiotomy (page P-53);- If the operator is not proficient in symphysiotomy, deliverby caesarean section (page P-43).- If the head is more than 3/5 above the symphysis pubis or theleading bony edge of the fetal head is above -2 station, deliverby caesarean section (page P-43).