Clinical Review ABC of labour care

Labour in special circumstances

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7191.1124 (Published 24 April 1999) Cite this as: BMJ 1999;318:1124
  1. Geoffrey Chamberlain,
  2. Philip Steer

    About two thirds of labours are normal. In the rest, increased surveillance—and sometimes action—is required to prevent maternal or fetal problems. All primary care givers need to be able to recognise such variations and either take appropriate action or refer to an obstetrician for advice and assistance. This may require transfer to hospital if the woman is in labour at home or in a freestanding general practitioner unit. A paediatrician should be called to attend if any problems are anticipated.

    The commonest problem in childbirth is a labour that is progressing slowly

    Descent of the fetal head into the pelvis is checked by abdominal examination when the head is imagined in segments of one fifth. Engagementwhen the maximum diameter of the fetal head has entered the pelviscorresponds with only two fifths of the head being palpable through the abdomen

    Slow progress (delay) in labour

    The fundamental process of labour is progressive dilatation of the cervix. The woman herself usually diagnoses labour when she has recurrent painful uterine contractions. However, such contractions may be ripening the cervix (the latent phase) before rapid cervical dilatation (the active phase) occurs. Midwives and doctors judge progress by assessing the descent of the fetal presenting part on abdominal palpation and advancement of the fetus on vaginal examination (position of the presenting part relative to the ischial spines). These may be imprecise measurements, but a series of careful assessments by the same observer is usually informative.

    The concept of the fetal head descending through the pelvis in labour is checked by vaginal examination when the level of the presenting part is assessed against the level of the ischial spines (in centimetres) vertically

    Labour is usually diagnosed by the professional when there are regular contractions or when the cervix has reached 3 cm dilatation in the presence of contractions. At this point, …

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