“Failure to progress” is retired: it blames the labouring person, it is imprecise, and it has been associated with caesareans performed before labour was given a fair chance. Describe instead. Sum Montevideo units from a ten-minute window with the arithmetic on the page, test the labour against the protracted and arrest definitions, see what each malpresentation puts against the pelvic inlet, and decide what tachysystole actually needs from you.
Measure it, then describe it
An intrauterine pressure catheter is in. Enter the peak pressure of every contraction in one 10-minute window, and the resting tone between them. Leave a box empty if there were fewer contractions.
Without a catheter you palpate instead: a contraction you can indent easily is mild, one that indents with difficulty is moderate, and one that feels like a forehead is strong.
Contemporary labour curves place the onset of the active phase at about 6 cm, not 4 cm, and the latent phase is now understood to be far longer and far more variable than the original curve implied.
Choose what is presenting. The drawing shows what fills — or fails to fill — the pelvic inlet, which is the single fact that predicts cord prolapse.
Two nursing observations run across all of them. First, in any malpresentation the moment membranes rupture is the moment of highest risk for cord prolapse — auscultate or observe the fetal heart rate immediately after every rupture, spontaneous or artificial, for a full minute. Second, an unengaged presenting part with ruptured membranes means the patient is not ambulated without a provider order.
Now choose what you would do. The tracing decides how far you go.
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Sum the windowPeak minus baseline, every contraction, ten minutes
Waiting
Enter the peaks and select Calculate Montevideo units.