SDM INSTITUTE OF NURSING SCIENCE
SUBJECT: MIDWIFERY AND OBSTETRICAL NURSING
TOPIC: PROLONGED LABOR
SUBMITTED TO, SUBMITTED BY
MS BIJLEE MANI MS VEENA SUDARSANAN
ASST PROFESSOR 1V th YEAR BSc (N)
DEPT OF OBG REG NO:15NO399
SDMIONS SDMIONS
INTRODUCTION
Prolonged labor or a failure to progress is the
inability of a woman to proceed with child birth
upon going into labor. Prolonged labor typically
lasts over 20 hours for the primi mothers and over
14 hours for multi parae mothers. Prolonged labor
is determined based on information that is being
collected regarding the strength and time between
contraction. Prolonged labor in the developing
world is commonly due to cephalo pelvic
disproportion.
DEFINITION
The labor is said to be prolonged when the
combined duration of the first stage and
second stage is more than the arbitrary time
limit of 18 hours.
Prolonged labor may be due to;-
Protracted cervical dilatation in first stage or
inadequate descent of the presenting part
during first or second stage of labor.
Cervical dilatation less than 1cm/h
Descent of the presenting part is less than
1cm/h for a period of minimum 4 hours
observation.
Inefficient uterine contraction.
PROLONGED LATENT PHASE
Latent phase is the preparatory phase of the
uterus and the cervix before the actual onset
of labor.
The mean duration of latent phase:- 8hrs in
primi gravidae and 12hrs in multiparae
A latent phase that exceeds:- 20hrs in primi
gravidae and 14hrs in multiparae.
CAUSES
a) Unripe cervix
b) Malposition and malpresentation
c) Cephalopelvic disproportion
d) Premature rupture of the membranes
e) Induction of labor
f) Early onset of regional anesthetic
First Stage:- Failure to dilate the cervix is due to,
Fault in power: Abnormal uterine contraction
such as uterine inertia(common) or incoordinate
uterine contraction.
Fault in passage: Contracted pelvis, Pelvic
tumor, Cervical dystocia.
Fault in passenger: Malposition and
malpresentation , congenital anomalies of the
fetus.
Others: Early administration of sedatives and
analgesics.
Second Stage:- Sluggish or non descent of the
presenting part in the second stage is due to;
Fault in power:
Uterine inertia
Inability to bear down
Regional (Epidural) analgesia
Constriction ring.
Fault in passage:
Cephalopelvic disproportion, android pelvis,
contracted pelvis
Undue resistance of the pelvic floor
Soft tissue pelvic tumor
• Fault in passenger:
Malposition
Malpresentation
Big baby
Congenital malformation of the baby
(A)First Stage:
First stage of labor is considered prolonged
when the duration is more than 12 hours.
Cervical dilatation is <1cm/h in primi and
<1.5cm/h in a multi.
The rate of the descent of the presenting part
is <1cm/h in a primi and <2cm/h in a multi.
In a partograph the labor process is divided
into;
A. Latent phase
B. Active phase
Cervical dilatation rate is plotted in relation
to alert line and action line:
Alert line:- Starts at the end of latent phase
and ends with full dilatation of the cervix in
6hours.
Action line:- The action line is drawn 4hours
to the right of alert line. A interval 4hours is
allowed to diagnose delay in active phase.
DISORDERS OF ACTIVE PHASE:-
i. Protraction
ii. Arrest disorders
Protracted Active Phase
iii.
The rate of cervical dilatation is <1.2cm/h in a
primipara and <1.5cm/h in multipara.
A protracted active phase may be due to;-
Inadequate uterine contractions
Cephalopelvic disproportion
Malposition or Malpresentation
Regional anaesthesia
i. Secondary Arrest
The active phase of labor commences normally
but stops or slows significantly for 2hours or
more prior to full dilatation of the cervix.
(B) Second Stage:
Mean duration of second stage is 50minutes
for nullipara and 20minutes in multipara.
Prolonged second stage if duration exceeds
2hours in nullipara and 1hours in multipara.
DISORDERS OF SECOND STAGE:-
(a) Protraction of the descent: Is defined when
the descent of presenting part is at <1cm/h
in nullipara or <2cm/h in multipara.
(b) Arrest of descent: No progress in descent is
observed over a period of atleast 2hours.
DANGERS: FETUS
The fetal risk is increased due to the combined
effects of:
o Hypoxia
o Intra uterine infection, Pneumonia
o Intra cranial stress or Hemorrhage
o Increased operative delivery
DANGERS: MATERNAL
o Distress
o Chorioamnionitis
o PPH
o Trauma to the genital tract
o Increased operative delivery
o Puerperal sepsis
o Subinvolution
DIAGNOSIS
Vaginal examination
Intra natal imaging
MANAGEMENT
Complete rest
Analgesics
Medical method are preferred
Amniotomy is usually avoided
TREATMENT
Prevention
Antenatal or early intranatal detection
Use of partograph
Selective and judicious augmentation
Change of posture in labor
Actual Treatment
Careful evaluation is to be done to find out;-
Cause of prolonged labor, effect on the mother,
effect on the fetus
In nulliparous patient inadequate uterine
activity
In multiparous patient cephalopelvic
disproportion
Definitive Treatment
First stage Delay- Vaginal examination, Clinical
Pelvimetry ,Oxytocin infusion, Analgesic
Second Stage Delay- Vaginal (forceps,ventouse)
or
cesarean
