Self-Assessment Questions (SAQs) for Study Session 9

Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering the following questions. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.

SAQ 9.1 (tests Learning Outcome 9.2)

Write down what you understand by the three ‘Ps’ and how they cause obstructed labour.


The three ‘Ps’ (powers, passenger and passage) are a shorthand way of describing the main causes of obstructed labour. After you have checked your answers with ours (below), re-read Section 9.2 for more detail about the causes.

  • Powers refers to the strength of the uterine contractions – too weak or uncoordinated and the baby is not pushed down the birth canal.
  • Passenger refers to the baby – if the head is too big or deformed, or if the position or presentation is wrong, the baby will not be able to pass down the birth canal.
  • Passage refers to the birth canal – if it is too small or deformed, or has blockages from tumours or scars, the baby will not be able to pass smoothly.

SAQ 9.2 (tests Learning Outcome 9.1)

Write down what you understand by the following terms:

  • a.Perinatal mortality and morbidity
  • b.Prolonged latent phase of labour
  • c.Prolonged second stage of labour
  • d.Malposition
  • e.Caput
  • f.Fistula


  • a.Perinatal mortality and morbidity - fetal and newborn deaths, and disease and disability occurring around the time of the birth.
  • b.Prolonged latent phase of labour - when true labour lasts for more than about 8 hours without entering into the active first stage.
  • c.Prolonged second stage of labour - when it lasts for more than 1 hour (for multigravida mothers) and more than 2 hours (primigravida mothers).
  • d.Malposition - when the baby is ‘head down’ but the vertex (the top of the baby’s skull) is in the wrong position relative to the mother’s pelvis.
  • e.Caput - a large central swelling on the fetal skull.
  • f.Fistula — an abnormal opening (usually resulting from a tear) between the vagina and the urinary bladder (or the rectum or urethra or ureter).

Read Case Study 9.3 and then answer the questions that follow it.

Case Study 9.1  Tadelech’s story

Tadelech lives in Mekit Woreda. The journey from village to city can take days, and she lives far from even a health post. Tadelech is 25 years old and has already delivered two children safely in the village. This is her third pregnancy. Contractions started at 40 weeks of gestation. After two days of labour Tadelech is carried on a home-made stretcher to your health post. When you examine Tadelech, finds two swellings (masses) over the abdomen, with a depression between them at about the level of the woman’s umbilicus (belly button). You also find that the baby’s head is not engaged (it is just above the pelvic brim). On vaginal examination, you estimate that Tadelech’s cervix is 8 cm dilated and the station of the fetal head is –3. Tadelech’s vagina is hot and dry and she has oedema of the vulva.

SAQ 9.3 (tests Learning Outcomes 9.1, 9.3 and 9.4)

  • a.From the case study what signs do you find that indicate prolonged or obstructed labour?
  • b.How do you manage Tadelech’s condition?


  • a.The following signs in Tadelech’s case study suggest both prolonged and obstructed labour:
    • It is clear that while Tadelech has been in the active first stage of labour for some time (dilated cervix of 8 cm), but she may actually be in a prolonged active phase of labour (when true labour lasts for more than about 8 hours without finally entering the second stage). Since you have not been monitoring her labour up to this point, you cannot be absolutely sure whether her cervix is dilating slowly, or if dilatation has completely ceased and the labour is not progressing at all.
    • The two swellings (masses) above and below the depression in her abdomen known as Bandl’s ring indicate an obstructed labour.
    • Furthermore, at -3 the baby’s head is not engaged, and remains above the pelvic brim; this indicates that it is not descending as you would expect it to do after Tadelech has been in labour for two days.
    • The hot and dry vagina and oedema (swelling due to collection of fluid in the tissues) of the vulva are further signs of a potential obstruction.
  • b.It is clear that Tadelech needs urgent referral to a health facility. Your actions should be to:
    • Explain this calmly to her and her family.
    • Activate the birth preparedness plan to get her transferred to a health facility as quickly as possible, together with her birth companion.
    • Tadelech’s vital signs suggest she is in shock: she has a fast pulse rate and low blood pressure). Her hot and dry vagina indicates dehydration. You begin treating her for shock and dehydration by giving her an intravenous infusion (see Section 9.4) and keeping it working during the trip to the higher health facility.
    • If the obstruction appears partly to be caused by an overfull bladder which the woman cannot empty in the normal way, you drain this using a catheter.

SAQ 9.4 (tests Learning Outcome 9.5)

How can you reduce the risks of a prolonged and obstructed labour for women giving birth at home?


You can reduce the risks of obstructed labour by:

  • Teaching the importance of good childhood nutrition to ensure that girls’ pelvic bones have the best chance of developing to the normal size for safe delivery.
  • Promoting family planning and discouraging early marriage and especially pregnancy at less than 18 years of age.
  • Explaining the importance for the safety of the mother and baby of having a skilled care attendant at all deliveries.
  • Assisting your community in organising birth preparedness teams so that in an emergency they can get the mother to the nearest health facility as quickly as possible.
  • Always using a partograph to monitor the progress of labour.

Summary of Study Session 9