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Progress & delay
When to suspect, confirm and act.
Source: NICE NG235 Calculator
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First stage
| Suspect | <2 cm in 4 h (parous: or slowing progress). |
|---|---|
| Confirm | Repeat VE after 2 h — <1 cm progress = delay. |
| Act | Consider amniotomy; re-examine 2 h later; still slow → obstetric-led care, oxytocin. |
| On oxytocin | VE 4 h after regular contractions — <2 cm: obstetric review for CS. |
Active second stage
| Nulliparous | Birth expected within 3 h; reassess at 1 h; senior review if not imminent at 2 h. |
|---|---|
| Parous | Birth expected within 2 h; reassess at 30 min; senior review if not imminent at 1 h. |
| With epidural | Delay pushing up to 2 h (nullip) / 1 h (parous) after full dilatation. |
Oxytocin: increase no more often than every 30 min; aim for 3–4 contractions in 10 min.
A summary for trained clinicians. Always check the full guideline, the patient in front of you and your hospital's protocol. Spotted an error? Tell us.