Prolonged labor is the inability of a woman to proceed with childbirth upon going into labor. Prolonged labor typically lasts over 20 hours for first time mothers, and over 14 hours for women that have already had children.

1. MRs : Babitha Mathew MSc OBG
Assistant professor
CON, NMC, Muvattupuzha

2. Definition
•“The labour is said to be
prolonged when the combined
duration of the first and second
stage is more than the arbitrary
time limit of 18 hours.”

3. The prolongation may be due to protracted cervical
dilatation in the first stage and/or inadequate descent of the
presenting part during the first or second stage of labor.
Labour is considered prolonged when the cervical dilatation
rate is less than 1 cm/hr and descent of the presenting part
is < 1 cm/hr for a period of minimum 4 hours observation
(WHO- 1994)

4. •Latent phase is the preparatory phase of the
uterus and the cervix before the actual onset of
labour.
•Mean duration of latent phase is about 8 hours
in a primi and 4 hours in a multi.
•A latent phase that exceeds 20 hours in
primigravidae or 14 hours in multiparae is
abnormal

5. •The causes include:-
1) Unriped Cervix
2) Malposition and Malpresentation
3) Cephalopelvic Disproportion
4) Premature Rupture of the Membranes
• Prolonged latent phase may be worrisome
to the patient but does not endanger the
mother or fetus.

6. •Expectant management is usually done unless there
is any indication (for the or mother) for expediting
the delivery.
•Rest and Analgesic are usually given
•When augmentation is decided, medical methods
( oxytocin or prostaglandins) are preferred.
•Amniotomy is usually avoided.
•Prolonged latent phase is not an indication for
cesarean section delivery.
PROLONGED LATENT PHASE MANAGEMENT

7. •
CAUSES OF PROLONGED LABOUR
FIRST STAGE
FAULT IN
POWER
FAULT IN
PASSAGE
FAULT IN
PASSENGER

8. Failure to dilate the cervix is due to:-
• FAULT IN POWER
• Abnormal Uterine Contraction such as uterine inertia or incoordinate uterine
contraction
• FAULT IN PASSAGE
• Contracted pelvis, cervical Dystocia, Pelvic Tumor, or even full bladder
• FAULT IN PASSENGER
• Malposition (OP) and Malpresentation (face, brow), congenital anomalies of the
fetus (hydrocephalus)
• Too often deflexed head, minor degrees of pelvic contraction and disordered
uterine action have got sinister (threatening) effect in causing non-dilatation of
cervix.
• OTHERS
• Injudicious (early) administration of sedatives and analgesics before the active
labour begins.

9. •
SECOND STAGE
FAULT IN
POWER
FAULT IN
PASSAGE
FAULT IN
PASSENGER

10. Sluggish or non-descent of the presenting
part in the second stage is due to:
1)Fault in the power:
(1) Uterine inertia
(2) Inability to bear down
(3) Epidural analgesia
(4) Constriction ring.
2)Fault in the passage:
(1) Cephalopelvic disproportion, android pelvis,
contracted pelvis
(2) Undue resistance of the pelvic floor or perineum
due to spasm or old scarring
(3) Soft tissue pelvic tumor.
3)Fault in the passenger:
(1) Malposition (occipito-posterior)
(2) Malpresentation
(3) Big baby
(4) Congenital malformation of the baby.

11. • Prolonged labour is not a diagnosis but it is the
manifestation of an abnormality, the cause of which
should be detected by a thorough abdominal and
vaginal examination
• During vaginal examination if the finger is accomodated
in between the cervix and the head during uterine
contraction pelvic adequecy can be reason ably
established.
• Intranatal imaging ( radiography, CT or MRI) is of help in
determining the fetal station and position as well as
pelvic shape and size.

12. FIRST STAGE
• Duration is > 12 hours. The rate of Cervical dilatation rate < 1 cm/hr
in primi and < 1.5 cm/hr in a multi
• Rate of descent of presenting part is <1 cm/hr in primi and < 2cm/hr
in multi
• DISORDERS OF ACTIVE PHASE
• A) Protracted (prolongated) active phase
• It may be due to:-
• Inadequate uterine contraction
• Cephalopelvic disproportion
• Malposition
• Malpresentation
• Epidural anaesthesia

13. • B) Arrest Disorder
• When no dilatation occurs after 2 hours in active phase of
labour
• Commonly due to:-
• Inefficient uterine contraction
• No descent for a period of > 1hour is called arrest of descent.
• It is commonly due to CPD
• Secondary Arrest
• When Active stage of labour commences normally but stops or
slows significantly for 2 hours or more prior to full dilatation of
the cervix
• Commonly due to malposition or CPD

14. SECOND STAGE
•Mean duration of second stage is 50 minutes for
nullipara and 20 minutes for multipara
•Prolonged stage is diagnosed if the duration
exceeds 2 hours in nullipara and 1 hour in a
multipara when no regional anesthesia used.
•1 hour or more is usually permitted in both the
groups when regional anesthesia is used during
labour.

15. (A) Protraction Descent
When:-
• Descent of presenting part is < 1 cm/hr in nullipara and < 2
cm/hr in multipara
(B) Arrest of descent
When:-
• no progress in descent is observed. It may be due to one or a
combination of several underlying abnormalities like CPD, malposition
(OP), malpresentation, inadequate uterine contradictions or
asynclitism.

16. (1) Hypoxia due to diminished uteroplacental
circulation specially after rupture of the membranes.
(2) Intrauterine infection
(3) Intracranial stress or hemorrhage following
prolonged stay in the perineum and/or supermoulding
of the head
(4) Increased operative delivery
FETAL

17. Distress
Puerperal sepsis
Chorioamnionitis
Increased
operative
delivery
Trauma
to the genital
tract
Postpartum
haemorrhage
Subinvolution.
Maternal:

18. •PREVENTION:-
•Antenatal or early Intranatal detection
•Use of partograph
•Selective and injudicious
augmentation
•Change of posture in labour, emotional
support, avoidance of dehydration in
labour and use of adequate analgesia
for pain relief

19. ACTUAL MANAGEMENT
•Careful evaluation is to be done to find out:-
•Cause of prolonged labour
•Effect on the mother
•Effect on the fetus
•In nulliparous women: Inadequete uterine activity,
primary dysfunctional labour
•In multiparous women: CPD,

20. PRELIMINERIES
• Correction of dehydration and ketoacidosis by IV fluids in case
of neglacted prolonged labour
DEFINITIVE TREATMENT
• FIRST STAGE DELAY
IF only uterine activity is suboptimal,
• Amniotomy/ oxytocin infusion
• Effective pain relief
• SECONDARY ARREST
• Careful use of oxytocin
• Cesarean section delivery

21. • SECOND STAGE DELAY
•Short period of expectant
management is reasonable
provided the FHR is reassuaring
and vaginal delivery is emminent
•Otherwise, appropriate assisted
delivery , vaginal or abdominal
should be done.
•Difficult instrumental delivery
should be avoided.