prolonged labour Definition Phases Causes Diagnosis Dangers Treatment

1. PROLONGED LABOUR
BY
Mrs.VIJAYALAKSHMI
LECTURER
GANGA COLLEGE OF NURSING
COIMBATORE

3. OUTLINE
• Definition
• Phases
• Causes
• Diagnosis
• Dangers
• Treatment

4. DEFINITION
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.

5. Latent phase
• 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

6. PROLONGED LATENT PHASE
A latent phase that exceeds
20 hrs in primigravida or
14 hrs in multigravida is abnormal.

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

9. • Alert line- start at the end of the
latent phase and end with the full
dilatation of cervix(10cm) in 7 hours.
( 1cm/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
cervicograp crosses the alert line

10. CAUSES
Unripe cervix
Malposition and malpresentation
Cephalopelvic disproportion
Premature rupture of the membranes
 Abnormal uterine contraction
contracted pelvis
congenital malformation
of the baby

11. CAUSES OF PROLONGED LABOUR
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.

12. Fault in passenger-
•Malposition and malpresentation
•Congenital anomalies of the fetus.
Others:
•Early administration of sedatives
•Analgesics before active labour
begins.

13. SECOND STAGE
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.

14. Fault in passage
•CPD
•Android pelvis
•Contracted pelvis
•Soft tissue
pelvic tumour
•Undue resistance
to the pelvic floor.

15. Fault in passenger
•Malposition and malpresentation
Big baby
•Congenital malformation of the baby.

16. DIAGNOSIS
It is not a diagnosis but it is the manifestation of an
abnormality.

17. 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 <2Cm/hr
in multi.

18. SECOND STAGE
The 2nd
stage is considered prolonged if it lasts for
more than 2 hrs in primi, and 1 hr in multi.

19. CONT……
The diagnostic features are
 Sluggish or non descent of the presenting part
even after full dilatation of the cervix.
 Variable degrees of molding and caput
formation in cephalic presentation.
 Identification of the cause of prolongation.

20. DANGERS
FETAL
The fetal risk is increased due
to the combined effects of
 Hypoxia
 Intrauterine infection
 Intracranial stress or
hemorrhage
 Increased
operative delivery

21. MATERNAL
There is increased incidence of
 Distress
 Postpartum hemorrhage
 Trauma to the genital tract
 Increased operative delivery
 Puerperal sepsis
 Subinvolution

22. TREATMENT
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.

23. CONT……
Change of posture in labour other than
supine to increase the uterine contractions.
Avoidance of labour dehydration.
Use of adequate analgesia for pain relif.

24. ACTUAL TREATMENT
Careful evaluation is done to find out
Causes of prolonged labour
Effect on the mother
Effect on the fetus

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

26. DEFINITIVE TREATMENT
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.

27. CONT…..
Amniotomy and or oxytocin infusion is adequate.
Effective pain relief is given by IM inj: Pethidine
or by regional analgesia.
Caesarean section is done when vaginal
delivery is unsafe.

28. SECOND STAGE DELAY
Short period of expectant management
is reasonable provided the FHR is reassuring and
vaginal delivery is imminent. Otherwise
appropriate assisted delivery vaginal
(forceps,ventouse)

30. CONT..
Abdominal (caesarean) should be done.