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Definition
The prolonged labour is defined when the combined duration of the first and second stage
of labour is more than the arbitary time limit of 18 hours. Labour is considered prolonged when
the cervical dilatation rate is less than 1cm/hr and descent of the presenting part is <1cm/hr for a
period of minimum 4 hours observations. It is calculated from mothers subjective estimate of
onset of true labour.
Prolonged latent phase: the latent phase is from onset of regular painful contraction with
cervical dilatation upto 4cm. If cervix is not dilated beyond 4cm for 8 hours of regular
contraction is considered as prolonged latent phase.
Prolonged active phase: the active phase is period from cervical dilatation 4-10cm.
Regular painful contractions with cervical dilatation more than 4cm last longer than 12
hour is considered as prolonged active phase. If the cervical dilatation arrests more than 2
hours is considered as abnormal.
Cervix is fully dilated and woman has urge to push but no descent is called prolonged
expulsive phase.
The second stage is considered prolonged if it lasts for more than 2 hours in primigravida
and 1 hours in multipara.
Second stage
Fault in power:- uterine inertia, inability to bear down, epidural analgesia, constriction
ring.
Fault in the passage:- CPD, Contracted pelvis, android pelvis, soft tissue pelvic tumour,
undue resistance of the pelvic floor or perineum due to spasm or old scarring.
The rate of cervical dilatation is less than 1cm/hour in primigravida and less than 1.5
cm/hour in multipara in first stage of labor.
There may be slow descent of head or non descend of presenting part even after full
dilatation of cervix.
Pain may be more on the radiating to the thighs rather than within abdomen due to
pressure on muscle and ligaments.
The uterus is tender on palpation does not relax fully between contraction.
Intrauterine infection
Mother risk
Maternal distress
Intrauterine infection
PPH
Subinvolution
Diagnosis
Abdominal examination
Intranatal radiography.
If there has been no change in cervical dilatation or effacement and no fetal distress,
review the diagnosis. She may not be in labour.
If she has not been enterd in active phase after 8 hours of induction, delivered by
caesarean section
If there is sign of infection immediately augment the labour with oxytocin and antibiotics
should be given like ampicilin and gentamycin untill delivery.
If not delivered vaginally delivered by caesarean section and continue antibiotics plus
metronidazole for 48 hours
If there is no sign of CPD and good contraction with membrane intact, ruptured the
membrane artificially.
If malpresentation and obvious obstruction have been excluded, augment labour with
oxytocin.
Elderly primigravidae
Prolonged pregnancy
Psychological factor
Contracted pelvis
Malpresentation
Full bladder