PROLONGED LABOUR

Hassan, MD

PROLONGED FIRST STAGE OF LABOUR

Diagnosis
Deviation of line of cervical dilatation to the
right of the alert line and reaches the action
line.
Causes
1. Powers i.e. uterine contractions
2. Passenger i.e. the fetus
3. Passage i.e. the pelvis.

Prolonged Latent Phase

Diagnosis
Diagnosis of labor has been made but progressive
cervical change occurs but at an inordinately slow
pace

Causes
Unripe cervix, false labor, sedation, uterine inertia

Complications
Maternal fatigue/exhaustion due to lack of sleep,
Maternal dehydration that can lead to a combination
of contractures and contractions

Prolonged Active Phase

Causes

Power: Ineffective contractions

Either they space out or have less strength to get the

effect needed.
Causes - maternal fatigue, pain (catacholamine
response), overmedication either in dose or timing.

Passenger: Big baby, malposition/presentation

Passage: contracted pelvis

PROLONGED FIRST STAGE OF LABOUR

Active management of labour

Indications
Accurate diagnosis of Labour
Primigravidae
Singleton fetus
Vertex presentation
No evidence of fetal distress

PROLONGED SECOND STAGE OF LABOR

Diagnosis
When the time exceeds 2 hours

Causes: Descent abnormalities

Fetal position/malpresentation/size
Ineffective contractions

Ineffective maternal effort

Medications/anesthesia

PROLONGED SECOND STAGE OF LABOUR

Management
Depends on the cause.

Poor uterine activity may be corrected

by augmentation.
Poor maternal effort or exhaustion assisted delivery (as long as all the
pre-requisites have been fulfilled).

PROLONGED THIRD STAGE OF LABOUR

Diagnosis
When exceeds 30 minutes

Causes
1. Uterine atony
Big uterus due to poly, multiple pregnancy, myoma,
following prolonged labour, traumatic delivery,
excessive analgesia, anaesthesia

2. Uterine abnormalities uterus & cervix

PROLONGED THIRD STAGE OF LABOUR

Causes
3. Placental

abnormalities

Problems of adhesion: placenta praevia, cornual

implantation, accreta, pancreta etc

4. Mismanagement of 3rd stage

Massage of uterus before delivery of the placenta

may lead to tetanic contractions,

Admin of ergot preparations too early or too late

sustained uterine contration traps the placenta

Occipito-Posterior Positions and Deep

Transverse Arrest
Occiput usually lateral when head
engages 80% will rotate to anterior during
labour

POPP
Causes delay in lst stage.
More common in primigravidae.
Treatment if inefficient uterus action may
result in rotation to anterior.

Occipito Posterior Position

Causes
Anteriorly situated placenta
Anthropoid pelvis

Flat Sacrum
Pundulous abdomen

Chance
R.O.P. three times as common as L.O.P.

Occipito Posterior Position

Management
12% will deliver spontaneously O.P.
Transverse arrest may require operative
intervention
Lack of progress may warrant c-section
Vacuum preferable to Forceps (?)

Complications of prolonged
obstructed labour
Maternal

Infection sepsis, peritonitis, wound infection,

Fistula
Thrombo-embolism
Ruptured Uterus
PPH
Broad Ligament Haematoma
Shock
Paralytic ileus
Burst abdomen

Fetal complications
1. Cord Prolapse
2.
3.
4.
5.
6.
7.
8.

Birth Asphyxia
Meconium Aspiration Syndrome
Convulsion
Jaundice
Neonatal Sepsis/Septicemia
Diarrhoea
Birth injury

An overview on pathophysiology of
prolonged obstructed labour

Maternal exhaustion and distress

Hypovolaemia
Electrolyte imbalance
Thrombo-embolism
Other cpxs

Ruptured Uterus
PPH
Obstetric fistulae
Infection, paralytic ileus

Management of prolonged obstructed

labour
Resuscitation: IV fluids RL or NS 1-2 Lfast,
use large bore cannula
Catheterization continuous bladder drainage

Blood gpg & x-matching

Antibiotics: i.v Ampicilin & metronidazole,
ceftriaxone

Deliver the mother by CS

PRECIPITOUS LABOR

Cervical dilatation rate

>5cm/hr dilatation in nullips; >10cm/hr in
multips

Complications of precipitous labor

Trauma to birth canal;
Fetal distress; and
Postpartum hemorrhage