Labor

1. Prolonged and
Difficult Labor

2. Definition:
Prolonged labor, also known as failure to
progress, occurs when labor lasts for
approximately 20 hours or more if you are a
first-time mother, and 14 hours or more if you
have previously given birth. A prolonged
latent phase happens during the first stage of
labor. It can be exhausting and emotionally
draining, but rarely leads to complications.
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3. Causes and risk factors of
prolonged and difficult
labor:
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• slow cervical dilations
• slow effacement
• a large baby
• a small birth canal or pelvis
• delivery of multiple babies
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Causes of prolonged and difficult labor:

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Risk Factors for prolonged labor:
• low oxygen levels for the baby
• abnormal heart rhythm in the baby
• abnormal substances in the amniotic fluid
• uterine infection

6. Pathophysiology
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7. Pathophysiology:
⬢ A prolonged latent phase may result from
oversedation or from entering labor early with a
thickened or uneffaced cervix. It may be
misdiagnosed in the face of frequent prodromal
contractions. Protraction of active labor is more
easily diagnosed and is dependent upon the 3 P’ s.
The first P, the passenger, may produce abnormal
labor because of the infant's size or from
malpresentation.
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Pathophysiology:
⬢ The second P, the pelvis, can cause abnormal
labor because its contours may be too small
or narrow to allow passage of the infant.
Both the passenger and pelvis cause
abnormal labor by a mechanical obstruction,
referred to as mechanical dystocia.

9. ⬢ With the third P, the power component, the frequency of uterine
contraction may be adequate, but the intensity may be
inadequate. Disruption of communication between adjacent
segments of the uterus may also exist, resulting from surgical
scarring, fibroids, or other conduction disruption. Whatever the
cause, the contraction pattern fails to result in cervical
effacement and dilation. This is called functional dystocia.
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Pathophysiology:

10. Diagnostic Tests and
Studies:
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11. Diagnostic Test and Studies:
⬢ The simplest test used to evaluate abnormal labor is to plot the
patient's labor progress (cervical dilation vs duration in hours)
on a labor curve.
⬢ A second test used to address adequate labor is the review of
the uterine contraction pattern by determining adequacy of
contractions with use of an intrauterine pressure catheter.
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12. Nursing Management and
Considerations
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13. Nursing Management:
⬢ Prolonged first stage of labor is one of the most frequent indications
for caesarean section
⬢ When labor progress deviates significantly from the alert line or
when the action line in the partograph is crossed, artificial rupture
of membranes, also called amniotomy, and augmentation of labor
with oxytocin are the recommended interventions to manage
prolonged labor.
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Pharmacological
Management

15. Pharmacologic management:
⬢ Augmentation of labor with oxytocin is the process of
stimulating the uterus to increase the frequency, duration
and intensity of contractions after the onset of spontaneous
labor. It has commonly been used to treat delayed labor
when poor uterine contractions are assessed to be the
underlying cause.
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16. THANKS!
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