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Obstetrics Simplified - Diaa M. EI-Mowafi

Prolonged Labour

The term is applied mainly to the prolongation of the first stage of labour.

The labour pattern is recorded on the partogram and prolonged labour can be identified as follow (Friedman 1983):

Pattern Diagnostic criterion
Prolonged latent phase Nulliparas
20 hours or more
14 hours or more
Primary dysfunctional labour
(protractional disorder)
< 1.2 cm / hour
< 1.5 cm / hour
Prolonged deceleration phase
(7-10 cm dilatation)
3 hours or more
1 hour or more
Secondary arrest of dilatation Arrest 2 hours or more
Protracted descent Nulliparas
< 1cm / hour
< 2cm / hour
Arrest of descent Arrest 1 hour or more  
Prolonged 2nd stage No descent in the 2nd stage  

The progression of labour is judged by two criteria:

  • The cervical dilatation.
  • Descent of the presenting part.

Most of the errors occur when the condition is diagnosed as there is no progress while the patient is still in the latent phase or even did not go into labour from the start.


  • Excessive analgesia.
  • Disproportion.
  • Malpresentations and malpositions.


  • Reassessment of the condition.
  • Pain relief: Pethidine or epidural analgesia.
  • Amniotomy: if membranes still intact.
  • Oxytocin: if amniotomy does not bring good uterine contractions and there is no contraindication for it.
  • Caesarean section is indicated in:
    • Failure of the above measures.
    • Disproportion.
    • Malpresentations not amenable for vaginal delivery.
    • Contraindications to oxytocin.
    • Foetal distress.