This document from the Ministry of Health of Ethiopia discusses abnormal progress of labor. It defines prolonged labor as lasting more than 12 hours in the active phase. Causes of slow labor progress include problems with contractions, the fetus, or the birth canal. The document provides guidance on using a partograph to monitor labor, identifying causes of abnormal progress, initial management including oxytocin or referral, and complications of obstructed labor such as sepsis, hemorrhage and uterine rupture.

1. Federal Democratic Republic of Ethiopia
Ministry of Health
BEmONC – LRP
ETHIOPIA
Best Practices in Maternal and Newborn Care
Abnormal Progress of Labor

2. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
Objectives
 Demonstrate ability to use partograph to
recognize abnormal progress of labour
 Identify the causes of abnormal progress of
labour
 Demonstrate ability to provide initial
management
 Refer a woman with prolonged/obstructed
labour
 Discuss the complications of obstructed
labour
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3. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
Unsatisfactory Progress of
Labor
 Unsatisfactory progress of labor is defined
as:
 Cervical dilatation to the right of the alert
line on partograph
 Prolonged labour is labour which lasts more
than 12 hours in the active phase.
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4. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
Causes of slow progress in labour:
 Powers
 Inadequate contractions (dysfunctional
labour)
 Passage
 Pelvis too small for baby (cephalopelvic
disproportion – CPD)
 Passenger
 Abnormal presentation or position
 Fetal abnormality e.g. hydrocephalus
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5. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
Initial management of prolonged
labour
 In first level facility: refer
 In higher level facility:
 Restore normal progress by giving oxytocin by
i/v infusion according to local regime and
 consider rupturing membranes if HIV negative
 Reassess in 2 hours
 If no further progress decide next step
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6. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
Remember!
 Slow progress may be due to any of the 3P’s
 The management of slow progress of labor
depends on the cause
 Augmentation with oxytocin may be
dangerous and cause rupture of uterus
and/or fetal distress
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7. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
Slow progress in second stage:
 Delay in descent of presenting
part
 Delay in expulsion
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8. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
Slow progress in 2nd stage:
Management
 Review maternal condition and refer
 Consider augmentation if in higher level
facility

 If foetal head >2/5 palpable deliver by C/S
 If foetal head < 2/5 palpable assist delivery
by vacuum extraction
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9. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
Symptoms & signs of Obstructed
labor(OL)
 Prolonged labor more
than 12 hrs in active
stage or total more
than 24 hrs
 Thirst
 Fever
 Lower abdominal pain
 Anxious & Restless
 Abnormal lie (
transverse)
 Horizontal ridge across
lower abdomen (three
tumor abdomen
comprising distended
bladder, upper & lower
segment of the uterus)
 Moderate to severe
molding
 Caput
 Absent FHB( IUFD/Fetal
distress)
Symptom OL Signs of OL
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10. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
Treatment & Advise
 Secure IV line with Normal Saline or Ringer
lactate solution
 Start IV broad spectrum antibiotics
 Insert Catheter
 Recruit two adult fit blood donors who will
donate
 Consult or refer for operative delivery
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11. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
 Sepsis
 Haemorrhage
 Uterine rupture
 Fistula formation
 Obstetrical palsy
 Death
 Birth trauma
 Birth asphyxia
 Intrauterine fetal
death
 Neonatal sepsis
 Perinatal death
Maternal
complications
Foetal complications
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12. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
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13. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
Obstructed labour – immediate care
 Assessment
 I/V fluids
 Antibiotics (parenteral)
 Delivery by appropriate method
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14. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
Obstructed labour – delivery
options
 Fetus alive  CS if at higher level facility
 Fetus dead  destructive procedure, (?CS
depending on the presentation of the baby & if
there are other C/I for vaginal delivery [e.g
previous scar])
 Ruptured uterus  laparotomy  repair, or
hysterectomy
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15. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
FETAL DISTRESS IN LABOR
 PROBLEMS
 Abnormal fetal heart rate (less than 100
or more than 180 beats perminute).
 Thick meconium-stained amnioticfluid.
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16. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
MANAGEMENT
 GENERAL MANAGEMENT
 Prop up the woman or place her on her
left side.
 Stop oxytocin if it is being administered.
 Open IV line to hydrate.
 Look for possible causes like cord
prolapse.
 Start intranasal oxygen

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17. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
Plan delivery
 If the cervix is fully dilated and the fetal
head is not more than 1/5 above the
symphysis pubis or the leading bony edge
of the head is at or below 0 station, deliver
by vacuum extraction or forceps;
 If the cervix is not fully dilated or the fetal
head is more than 1/5 above the
symphysis pubis or the leading bony edge
of the head is above 0 station,
consult/refer for delivery by C/S.
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18. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
Summary:
 Unsatisfactory progress of labor can be
detected if cervical dilatation is to the right
of the alert line on partograph
 Prolonged labour is labour which lasts more
than twelve hours in the active phase.
 Causes of slow progress in labour could be
problem in power, passenger or passage
 Cases of prolonged labour need to be
referred to a higher level and managed
according to the cause
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