Definition , Latent phase,prolonged latent phase , Causes, diagnosis first stage , second stage , treatment first stage ,second stage

2. 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 hrs

3.  Latent phase is the preparatory phase of the uterus
and the cervix before the actual onset of labour .
 Normal latent phase is about
8 hours in primi
4 hours in multi

4. A latent phase that exeeds
20 hours in primigravida or
14 hours in multigravida is abnormal

7.  In a partograph the labour process divided into
 Alert line
 Action line
Latent phase : latent phase that end with the cervix
is 3 cm dilated
Active phase : starts with cervical dilatation of
3 cm cervix should dilate at least 1 Cm / hr

8.  Alert line – start at the end of the latent phase and
end with the full dilatation of cervix (10cm) in 7
hours . ( 1 cm / hr dilatation)
 Action line – its drawn four hours to the right of the
alert line . An interval of 4 hours is allowed to
diagnose delay in active phase and then appropriate
intervention is done .
Labour is considered abnormal when cervicograph
crosses alert line

9.  Unripe cervix
 Malposition and malpresentations
 Cephalopelvic disproportion
 Premature rupture of the membranes
 Abnormal uterine contractions
 Contracted pelvis
 Congenital malformations of the baby

10. First stage
Failure to dilate the cervix is due to
 Fault in power – Abnormal uterine contraction such
as
- Uterine inertia
- In co-ordinate uterus contraction
 Fault in passage -
- Contracted pelvis
- Cervical dystocia
- Pelvic tumor or even full bladder

11.  Fault in passenger –
 Malposition and malpresentations
 Congenital anamolies of the fetus
 Others :
 Early administrations of sedatives
 Analgesics before active labour begins

12. Sluggish or non descent of the presenting part in
2nd stage due to
 Fault in power
 Uterine inertia
 Inability to bear down
 Epidural analgesia
 Constriction ring

13.  Fault in passage
 CPD
 Android pelvis
 Contracted pelvis
 Soft tissue
 Pelvic tumour
 Undue resistance to the pelvic floor

14.  Fault in passenger
 Malposition and Malpresentations
 Big baby
 Congenital malformation of the baby

15. It is not a diagnosis but it is the manifestation of an
abnormality .
FIRST STAGE
First stage of labour is considered prolonged when
the duration is more than 12 hrs . The rate of
cervical dilatation is < 1 cm / hr in primi and < 1.5
cm / hr in multi . The rate of descent if the
presenting part is < 1 cm / hr in primi and
< 2 cm / hr in multi

16. The 2nd stage is considered prolonged if it lasts for
more than 2 hrs in primi , and 1 hr in multi.
The diagnostic features are –
 Sluggish or non descent of the presenting part even
after full dilatation of the cervix
 Variable degrees of moulding and caput formation
in cephalic presentation
 Identification of the cause of prolongation

17. FETAL
The fetal risk is increased due to combined effects of
 Hypoxia
 Intrauterine infection
 Intracranial stress or hemorrhage
 Increased operative delivery

18. There is increased incidence of
 Distress
 Postpartum hemorrhage
 Trauma to genital track
 Increased operative delivery
 Puerperal sepsis
 Subinvolution

19. PREVENTION
 Antenatal or early intranatal detection of the factors
likely to produce prolonged labour
 Use of partograph
 Selective and judicious augmentation of labour by
low rupture of membranes followed by oxytocin
drip.

20.  Change of posture in labour other than supine to
increase the uterine contractions
 Avoidance of labour dehydration
 Use of adequate analgesia for pain relief

21. Careful evaluation is done to find out
 Causes of prolonged labour
 Effect on the mother
 Effect on the fetus

22.  Correction of keto-acidosis should be done
urgently by rapid intravenous infusion of Ringer’s
solution .

23. FIRST STAGE DELAY
 Vaginal examination is done to verify the fetal
presentation , position and station . Clinical pelvimetry
is done , if only uterine activity is suboptimal
 Amniotomy and or oxytocin infusion is adequate
 Effective pain relief is given by IM inj : Pethidine or
by regional analgesia.
 Caeserian section is done when vaginal delivery is
unsafe

24. Short period of expectant management is
reasonable provided the FHR is reassuring and
vaginal delivery is imminent . Otherwise
appropriate assisted vaginal delivery
(forceps, ventose)

25. FORCEP DELIVERY

27. LSCS Should be done

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