System Level Indicators (Inputs)

Obstructed Labor Management Chart Review GUIDE Sampling Criteria : Any chart in which active labor lasts >12 hours Based on Liberia National Treatment Guidelines & WHO guidelines

Admission Cervical dilation Cervical dilation recorded at admissionpartograph started when cervical dilation 4 cm or greater (active labor) Fetal presentation Fetal presentation recorded (vertex vs. Breech)

Contractions Frequency & duration of contractions documented (in active labor, contractions at least 3 or more every 10 minutes lasting at least 40 seconds) Labor Monitoring Cervical dilation Cervical dilation recorded at least every 4 hours Contractions Frequency and duration recorded at least every 30 minutes Note : in active labor contractions should be at least 3 per 10 minutes lasting at least 40 seconds) Fetal HR Fetal HR recorded at least every 30 minutes Recognition & Assessment of Unsatisfactory Progress of Labor General recognition  Cervical dilation not greater than 4 cm after 8 hours of regular contractions (prolonged latent phase)  Cervical dilation is to the right of the alert curve on the partogram (unsatisfactor progress active labor)  Active labor 12 hours without delivery Cause evaluated  Malpresentation of fetus (e.g.breech)  Inadequate uterine activity (2 contractions or less in 10 minutes each lasting <40 seconds)  Cephalopelvic disproportion (secondary arrest of cervical deliation and descent of presenting fetus part) Action Taken if Inadequate Uterine Activity or Obstructed Labor (cervical dilation to right of alert curve) Inadequate Uterine Rupture of membranes using sterile technique Activity Augmentation with oxytocin IF experienced competent provider on site and no contra-indications ; otherwise refer to higher level facility. Obstructed Labor  Assisted delivery (e.g. vaccuum extraction) if cervix fully (no progression despite dilated, fetal head is at 0 station or lower, no fetal distress and adequate trial of labor) competent provider available  Cesarian section if: a) cervix not fully dilated ; b) fetal head too high for vaccum extraction ; 3) competent provider and equipment not available for assisted delivery Secondary Measures Begin antibiotics if labor over 24 hours or ROM over 18 hours at any time in first or second stage of labor Final Outcome Delivery within 2 hrs of crossing action line on partograph