PROLONGED LABOUR

Mr. Kamau
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 3
rd
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. Birth Asphyxia
3. Meconium Aspiration Syndrome
4. Convulsion
5. Jaundice
6. Neonatal Sepsis/Septicemia
7. Diarrhoea
8. 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