Abnormal labor is defined as any deviation from the normal progress of labor due to various factors including dysfunctional uterine activity, fetal issues, pelvic inadequacies, or maternal conditions. Diagnosis involves monitoring labor phases and recognizing patterns of protraction or arrest disorders, with management strategies typically including oxytocin administration or cesarean section if progress stalls. Risks associated with abnormal labor include maternal anxiety, fetal distress, and complications such as obstructed labor or uterine rupture.

1. Abnormal Labour
CHN

2. Definition
Any deviation in normal progress of labour, either in
cervical
dilatation or descent of the presenting part, despite the
presence
of uterine contraction.
Dystocia refers to abnormal or difficult labour.

3. Etiology
a. Power: dysfunctional uterine activity
– Malfunction in the myogenic, neurogenic, or hormonal mechanisms of uterine
activity.
b. Passenger: issues with the fetus
– Malpresentation, malposition, fetal anomalies
c. Passage: shape and size of the pelvis. A small pelvis may be inadequate
for successful vaginal delivery.
– Uterine malformations, pelvic tumors, uterine over distension
– CPD
d. Patient(mother)
– Psychological condition, pain, hydration, bladder, patient’s position, other
comorbidities.

4. Diagnosis ???
Partogram

5. Classification
1. Prolonged latent phase
2. Protraction disorders
a. Protracted active phase
b. Protracted descent
3. Arrest disorders
a. Secondary arrest of cervical dilatation
b. Prolonged deceleration phase
c. Arrest of descent
d. Failure of descent

6. Curves of Normal and Abnormal Labor
Prolonged
Latent
Phase
Protracted
Active Phase
2ry Arrest
of Dilation
Prolonged
Latent
Phase
Protracted
Active Phase
2ry Arrest
of Dilation

7. Prolonged latent phase
• The presence of intact membranes and a normal fetal heart rate
pattern, poses no risk to either the mother or fetus
• More than 20 hr in PG, >14 hrs in MG from the onset of labour.
• Incidence; 4 and 1 percent in prim and multig respectively.
• Etiology
 Wrong diagnosis of labour
 Excess sedation
 An abnormal or high presenting part
 PROM
 Idiopathic

8. Risks
If membranes are intact, no risk but maternal anxiety
Risks are created by aggressive interventions.

9. Primary dysfunctional labour
• Cervical dilatation less than 1 cm per hr before normal active phase has
been established.
• Cervical dilatation of less than 1 cm per hr for two consecutive hrs in
the active phase.
• Etiology
 Poor contractions
 CPD
Fetal: malposition, malformation, macrosomia.
Maternal: small stature, contracted pelvis
Both
 Malpresentation
 Maternal abnormalities

10. Risks
1. Fetal distress
2. Maternal fear and anxiety, dehydration
3. Obstructed labour; chorioamnionitis, uterine rupture
and PPH.

11. Management
• Exclude CPD ARM and oxytocin drip
• CS if there is no progress after 4 hours

12. Malpresentation
• Breech presentation.
• Face presentation.
• Brow presentation .
• Shoulder presentation .
o Common in multipara
o Increased risk of uterine rupture if labour becomes obstructed