A primigravida is in labour for 8 hours, when you notice that labour curve comes to the right of the alert line. What will you do next ?

Question

Question

This question was previously asked in

KGMU Nursing Officer 2023 Memory-Based Previous Year Paper

Answer 1

Correct Answer: Shift patient for Caesarean section

Rationale:

The labour curve, also known as the partogram, is a graphical representation of the progress of labour. When the labour curve moves to the right of the alert line, it indicates a deviation from normal labour progression, which could signal a delay or obstruction in labour.
In such cases, it is essential to evaluate the underlying cause of the delay promptly. If the delay persists or becomes severe, it may compromise maternal and fetal health.
A Caesarean section is the definitive intervention to ensure the safety of both the mother and the baby when labour is not progressing adequately, and conservative measures are insufficient or inappropriate.
Delays in labour can lead to complications such as fetal distress, uterine rupture, or maternal exhaustion. A Caesarean section is often indicated when these risks outweigh the benefits of continuing with vaginal delivery.

Explanation of Other Options:

Check uterine contractions

Rationale: While assessing uterine contractions is an important step in managing delayed labour, it is not the definitive solution in this case. If the labour curve is already to the right of the alert line, it indicates a significant delay, and further evaluation or intervention is required beyond just monitoring contractions.

Give injection Oxytocin

Rationale: Oxytocin is used to augment labour by stimulating uterine contractions. However, its administration must be cautious and based on a thorough assessment. If the labour curve is already abnormal, there could be other underlying issues such as cephalopelvic disproportion or fetal malposition, which cannot be resolved with oxytocin alone. Misuse of oxytocin in such cases could lead to complications like uterine hyperstimulation or rupture.

Start normal saline infusion

Rationale: Starting a normal saline infusion can be part of supportive care for the mother, especially if she is dehydrated or needs fluid replacement. However, this does not address the underlying issue of delayed labour progression, and hence it is not the primary management in this scenario.

Conclusion:

When the labour curve moves to the right of the alert line, it is a sign of abnormal labour progression. After initial assessments, if the delay persists and poses risks to the mother or fetus, a Caesarean section is the safest and most appropriate intervention to ensure the well-being of both.