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
Multiparas

20 hours or more
14 hours or more

Primary dysfunctional labour
(protractional disorder)

Nulliparas
Multiparas

< 1.2 cm / hour
< 1.5 cm / hour

Prolonged deceleration phase
(7-10 cm dilatation)

Nulliparas
Multiparas

3 hours or more
1 hour or more

Secondary arrest of dilatation

Arrest

2 hours or more

Protracted descent

Nulliparas
Multiparas

< 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.

Causes

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

Management

  • 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.

Links

 

 

 
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Edited by Aldo Campana,