Obs-Gyn Delayed delivery:

General inspection:
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Maternal body habitus (obesity risk for post-dates, and failed vaginal delivery)
Maternal ABCs:
o General health and medical stability
o Contractions? Are they in labour and its not progressing, or have gone postdates without starting?
Does she feel pregnant, foetal movements etc

History:
Gestational / antenatal history:
- Prior pregnancies, prior deliveries? Current pregnancy single or multiple?
- Antenatal care until now? Ultrasounds, screening tests, foetal health and growth,
symmetry, macrosomia, hydrocephalus etc
- Dating of gestational age? LNMP vs ultrasound, and which USS was used?
- Plan for this delivery? NVD / VBAC / LUSCS
Medical / surgical history:
- Medications, pre-existing conditions
- Surgical history, safety of anaesthesia, procedures / instrumentation of uterus
AMPLE history:
- Allergies, medications, prior medical and surgical Hx, last eaten / drank / toileted,
events around this event

Examine:
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Foetal size, lie, presentation, engagement and station

Foetal measurements: HR and uterine contractions
Maternal health:
o BP / HR / RR / temp
o Membranes

Treatment:
- Consider induction of labour if in appropriate positioning (cephalic) and not already
active:
o Priming of cervix with prostaglandin
o Artificial rupture of membranes (dont do if any risk of cord prolapse)
o Syntocinon infusion
- Monitor for hyperstimulation problems, foetal distress
- Instrumented delivery if passage is going well but effort is not appropriate
- Caesarian if prolonged labour without success, or if foetal distress.

Other areas:
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CTG reading:
o Foetal HR (110-160), variability (5-25bpm)
o Accelerations (2+ per 20 mins, at least 15 seconds, at least +15bpm)
o Decelerations
Early is ok via pain and pressure;
Variable has variable significance depending on rebound and return to
baseline, acts through pressure on cord, altered perfusion and vascular
resistance and return;
Late is foetal hypoxia via impaired perfusion
DDx: maternal hypotension (Haemorrhage, analgesia, anaphylaxis,
amniotic fluid embolism); maternal hypoxia; placental abruption /
insufficiency; cord compression (prolapse, around neck, in hands, etc);
uterine rupture, uterine hyperstimulation
o Contractions: frequency and magnitude, compare to previous patterns, consider
the patients ability to feel them, hyperstimulation
Partogram reading:
o Rate of dilation (1+cm per hour after 4cm)
o Rate of descent
o Maternal BP / HR / temperature

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Rupture of membranes: presence / absence, and duration