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Abnormal Progress in Labour - Coggle Diagram

- - - - Physiological
      - Active
        
        Oxytocin injection IM
        
        Controlled cord taction delivery of placenta
- - - - 3-4 in 10 min
      - Frequency
        Duration
        Strength
        Regularity
    - - Active 2nd stage of labour
  - - - Inlet
      - Outlet
  - - - Foetal Size
        
        Abnormality
        
        Cephalopelvic disproportion CPD
        
        SFH
      - Foetal presentation
        
        Malpresentation
        
        Breech
        
        Deflexed
        
        Brow
        
        Normal Presentation
        
        Cephalic vertex presentation
      - Foetal position / Foetal back
        
        Malposition
        
        OP
        
        Deep transverse arrest
        
        Normal position
        
        Head enters in transverse position
        
        Back lateral
      - Engagement
        
        2/5, 1/5, 0/5
        
        4/5 , 5/5 - could be CPD
    - - Caput - scalp swelling
        
        Late in labour: Obstruction, CPD
      - Moulding - skull bone remodelling
        
        Expectant in advanced labour
        
        Considerable moulding / failure to decend → obstruction
      - Station - descent / ischial spines
        
        Vaginal version of engagement - how low or high presenting part is
        
        -3 to +3
      - Position - Rotation of occiput
        
        OA for crowing and birth
        
        Identified by landmarks of foetal skull
      - Attitude - Flexion / deflexion
        
        Anormal
        
        Deflexion in OP position
      - Asynclitism - Lateral flexion / tilt
        
        May be indication of malposition / CPD
- - - - Inefficient Maternal effort
      - Inefficient contractions
    - - ARM 1️⃣ line
        
        Releases prostaglandins
        
        Increases strength + frequency of contractions
      - Oxytocin infusion 2️⃣ line
      - Change position (urge to push)
      - Encouragement
  - - - Pelvis shape
      - Tight muscles
      - Small pelvis
    - - Cannot correct shape of pelvis - can correct malposition / descent
  - - - Malpresentation
      - Malposition
      - Macrosomia
    - - Oxytocin infusion (after rupture of membranes)
      - Change position
      - Assisted birth
        Depends of stage of albour
        
        1st stage
        
        CS
        
        2nd stage
        
        Forceps
        
        Vaccum
        
        Episiotomy
        
        3rd stage
        
        Controlled cord traction
- - - - Prolonged 2nd stage > 1-2 hours active
      - Suspected foetal compromise - CTG / FBS / Mec
      - Maternal medical conditions - marked HTN / caridac condition
    - - Expertise / Consent / Analgesia
      - Fully engaged
      - Bladder empty
      - Fully dilated / membranes ruptured
      - Position known
      - Station below spines
    - - Failed attempt
        
        Second instrument
        
        CS
      - Trauma to baby
        
        Scalp
        Brain
        Skull
        Nerve
      - Trauma to mother
        
        Tears
        
        PPH
        
        Psychological