students learn about management of prolonged labor

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 hours.”

3. Failure to progress normal childbirth process.

4. 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)

5. Prolonged labour is not synonymous
with inefficient uterine contraction can
be a prolonged labour but labour may
also be prolonged due to pelvic or fetal
factor.

6. 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.
Whether prolonged latent phase has
got any adverse effect on the mother or
on the fetus, it is not clearly known.

7. A latent phase that exceeds 20 hours in
primigravidae or 14 hours in multiparae is
abnormal.
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.

8.  Expectant management is usually done
unless there is any indication (for the
fetus or mother) for expediting the
delivery.
 Rest and Analgesic are usually given
 When augmentation is decided,
medical methods ( oxytocin or
prostaglandin) are preferred.

9.  Amniotomy is usually avoided.
 Prolonged latent phase is not an
indication for cesarean section delivery.

10. FIRST STAGE
FAULT IN
POWER
FAULT IN
PASSAGE
FAULT IN
PASSENGER

11. 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)

12. 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.

13. SECOND STAGE
FAULT IN
POWER
FAULT IN
PASSAGE
FAULT IN
PASSENGER

14. Sluggish or non-descent of the presenting part
in the second stage is due to:-
FAULT IN POWER
Uterine Inertia, Inability to bear Down,
Epidural Analgesia, Constriction Ring
FAULT IN PASSAGE
Cephalopelvic disproportion,
Android pelvis,contracted pelvis, undue
resistance of the pelvic floor or perineum
due to spasm or oldscarring

15. FAULT IN PASSENGER
Malpostition (occipito-posterior),
Malpresentation, Big Baby, Congenital
Malformation of the baby.

16. 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
reasonably established.

17. • Intranatal imaging ( radiography, CT or
MRI) is of help in determining the fetal
station and position as well as pelvic
shape and size.
FIRST STAGE
 Duration is > 12 hours
 Cervical dilatation rate < 1 cm/hr in
primi and < 1.5 cm/hr
 Rate of descent of presenting part is
< 1 cm/hr in primi and < 2 cm/hr in
multi

18. A) Protracted (prolongated) active phase
 It may be due to:-
Inadequate uterine contraction
Cephalopelvic disproportion
Malposition
Malpresentation
Epidural anaesthesia
DISORDERS OF ACTIVE PHASE

19. 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

20. 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

21. 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.

22. A) Protraction Descent
When:-
Descent of presenting part is < 1 cm/hr
in nullipara and < 2 cm/hr in multipara
May be due to one or combination of
several underlying abnormalities like
CPD, Malposition, Malpresentation,
Inadequet uterine contraction
DISORDERS OF SECOND STAGE

23. FETAL
HYPOXIA
INTRA
UTERINE
INFECTION
INTRA
CRANIAL
STRESS OR
HAEMORRHA
GE
INCREASED
OPERATIVE
DELIVERY

24. MATERNAL
DISTRESS
PPH
GENITAL
TRACT
TRAUMA
INCREASED
OPERATIVE
DELIVERY
PUERPERAL
SEPSIS
SUB
INVOLUTION

25. PREVENTION:-
Antenatal or early intranatal detection
Use of partograph
Selective and injudicious augmentation
Change of posture in labour

26. 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,

27. PRELIMINERIES
Correction of dehydration and
ketoacidosis by IV fluids in case of
neglacted prolonged labour

28. 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

29. 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.