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.
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