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    Prolonged Labour: Mrs. Shwetha Rani C.M

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    Santhosh.S.U
    Prolonged labour is defined as labour lasting more than 18 hours. It can be caused by issues with uterine contractions (fault in power), pelvic structure (fault in passage), or fetal position (fault in passenger). Prolonged labour increases risks for both mother and baby, such as hypoxia, infection, and physical trauma. Treatment involves identifying the cause, correcting dehydration or acidosis, administering oxytocin or changing positions to improve contractions, and potentially expedited delivery by assisted vaginal delivery or C-section if problems persist. Careful evaluation and monitoring is important to address prolonged labour safely.

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    Prolonged Labour: Mrs. Shwetha Rani C.M

    Uploaded by

    Santhosh.S.U
    2K views24 pages
    Prolonged labour is defined as labour lasting more than 18 hours. It can be caused by issues with uterine contractions (fault in power), pelvic structure (fault in passage), or fetal position (fault in passenger). Prolonged labour increases risks for both mother and baby, such as hypoxia, infection, and physical trauma. Treatment involves identifying the cause, correcting dehydration or acidosis, administering oxytocin or changing positions to improve contractions, and potentially expedited delivery by assisted vaginal delivery or C-section if problems persist. Careful evaluation and monitoring is important to address prolonged labour safely.

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    Prolonged Labour

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    Prolonged labour is defined as labour lasting more than 18 hours. It can be caused by issues with uterine contractions (fault in power), pelvic structure (fault in passage), or fetal position (fault in passenger). Prolonged labour increases risks for both mother and baby, such as hypoxia, infection, and physical trauma. Treatment involves identifying the cause, correcting dehydration or acidosis, administering oxytocin or changing positions to improve contractions, and potentially expedited delivery by assisted vaginal delivery or C-section if problems persist. Careful evaluation and monitoring is important to address prolonged labour safely.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    2K views24 pages

    Prolonged Labour: Mrs. Shwetha Rani C.M

    Uploaded by

    Santhosh.S.U
    Prolonged labour is defined as labour lasting more than 18 hours. It can be caused by issues with uterine contractions (fault in power), pelvic structure (fault in passage), or fetal position (fault in passenger). Prolonged labour increases risks for both mother and baby, such as hypoxia, infection, and physical trauma. Treatment involves identifying the cause, correcting dehydration or acidosis, administering oxytocin or changing positions to improve contractions, and potentially expedited delivery by assisted vaginal delivery or C-section if problems persist. Careful evaluation and monitoring is important to address prolonged labour safely.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 24

    Prolonged Labour

    Mrs. Shwetha Rani C.M.


    Associate Professor & H.O.D.
    Department of Obstetric & Gynecological Nursing
    SCPM College Of Nursing & Paramedical Sciences,
    Gonda. U.P.
    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
    hours.”
    Failure to progress normal childbirth
    process.
    • The prolongation may be due to protracted cervical dilatation in the
    first stage and/or inadequate descent of the presenting part during
    the first or second stage of labor.
    • Labour is considered prolonged when the cervical dilatation rate is
    less than 1 cm/hr and descent of the presenting part is < 1 cm/hr for
    a period of minimum 4 hours observation (WHO- 1994).
    • Prolonged labour is not synonymous with inefficient uterine
    contraction can be a prolonged labour but labour may also be
    prolonged due to pelvic or fetal factor.
    Prolonged Latent Phase
    • Latent phase is the preparatory phase of the uterus and the cervix
    before the actual onset of labour.
    • Mean duration of latent phase is about 8 hours in a primi and 4
    hours in a multi.
    • Whether prolonged latent phase has got any adverse effect on the
    mother or on the fetus, it is not clearly known.
    • A latent phase that exceeds 20 hours in primigravidae or 14 hours in
    multiparae is abnormal.
    • The causes include:-
    1) Unriped Cervix
    2) Malposition and Malpresentation
    3) Cephalopelvic Disproportion
    4) Premature Rupture of the Membranes
     Prolonged latent phase may be worrisome to the patient but does
    not endanger the mother or fetus.
    • Expectant management is usually done unless there is any indication
    (for the fetus or mother) for expediting the delivery.
    • Rest and Analgesic are usually given
    • When augmentation is decided, medical methods ( oxytocin or
    prostaglandin) are preferred.
    • Amniotomy is usually avoided.
    • Prolonged latent phase is not an indication for cesarean section
    delivery.
    Causes of Prolonged Labour

    First Stage.

    Fault in
    Power.

    Fault in
    Passage.

    Fault in
    Passenger.
    Failure to dilate the cervix is due to:-
    • FAULT IN POWER
    • Abnormal Uterine Contraction such as uterine inertia or
    incoordinate uterine contraction
    • FAULT IN PASSAGE
    • Contracted pelvis, cervical Dystocia, Pelvic Tumor, or even full
    bladder
    • FAULT IN PASSENGER
    • Malposition (OP) and Malpresentation (face, brow), congenital
    anomalies of the fetus (hydrocephalus)
    • Too often deflexed head, minor degrees of pelvic contraction and
    disordered uterine action have got sinister (threatening) effect in
    causing non-dilatation of cervix.
    • OTHERS
    • Injudicious (early) administration of sedatives and analgesics before
    the active labour begins.
    SECOND
    STAGE

    FAULT IN
    POWER

    FAULT IN
    PASSAGE

    FAULT IN
    PASSENGER
    • Sluggish or non-descent of the presenting part in the second stage is due to:-
    • FAULT IN POWER
    • Uterine Inertia, Inability to bear Down, Epidural Analgesia, Constriction Ring,
    • FAULT IN PASSAGE
    • Cephalopelvic disproportion, Android pelvis, contracted pelvis, undue
    resistance of the pelvic floor or perineum due to spasm or oldscarring.
    • FAULT IN PASSENGER
    • Malpostition (occipito-posterior), Malpresentation, Big Baby, Congenital
    Malformation of the baby.
    Diagnosis
    • Prolonged labour is not a diagnosis but it is the manifestation of an
    abnormality, the cause of which should be detected by a thorough
    abdominal and vaginal examination
    • During vaginal examination if the finger is accomodated in between
    the cervix and the head during uterine contraction pelvic adequecy
    can be reasonably established.
    • Intranatal imaging ( radiography, CT or MRI) is of help in determining
    the fetal station and position as well as pelvic shape and size.
    • FIRST STAGE
    • Duration is > 12 hours
    • Cervical dilatation rate < 1 cm/hr in primi and < 1.5 cm/hr
    • Rate of descent of presenting part is < 1 cm/hr in primi and < 2
    cm/hr in multi
    DISORDERS OF ACTIVE PHASE
    A) Protracted (prolongated) active phase
    • It may be due to:-
    • Inadequate uterine contraction
    • Cephalopelvic disproportion
    • Malposition
    • Malpresentation
    • Epidural anaesthesia
    B) Arrest Disorder
    • When no dilatation occurs after 2 hours in active phase of labour
    • Commonly due to:-
    • Inefficient uterine contraction
    • No descent for a period of > 1hour is called arrest of descent.
    • It is commonly due to CPD.
    • Secondary Arrest
    • When Active stage of labour commences normally but stops or slows
    significantly for 2 hours or more prior to full dilatation of the cervix
    • Commonly due to malposition or CPD
    SECOND STAGE
    • Mean duration of second stage is 50 minutes for nullipara and 20
    minutes for multipara
    • Prolonged stage is diagnosed if the duration exceeds 2 hours in
    nullipara and 1 hour in a multipara when no regional anesthesia
    used.
    • 1 hour or more is usually permitted in both the groups when
    regional anesthesia is used during labour.
    DISORDERS OF SECOND STAGE
    A) Protraction Descent
    • When:-
    • Descent of presenting part is < 1 cm/hr in nullipara and < 2 cm/hr in
    multipara
    • May be due to one or combination of several underlying
    abnormalities like CPD, Malposition, Malpresentation, Inadequet
    uterine contraction
    Dangers
    Hypoxia

    Increased Intra
    Operative
    Delivery
    Fetal Uterine
    Infection

    Intra Cranial Stress


    or Haemorrhage
    Distress

    Sub
    PPH
    Involution

    Maternal

    Genital
    Puerperal
    Tract
    Sepsis
    Trauma

    Increased
    Operative
    Delivery
    Traetment
    • PREVENTION:-
    • Antenatal or early intranatal detection
    • Use of partograph
    • Selective and injudicious augmentation
    • Change of posture in labour
    • ACTUAL MANAGEMENT
    • Careful evaluation is to be done to find out:-
    • Cause of prolonged labour
    • Effect on the mother
    • Effect on the fetus
    • In nulliparous women: Inadequate uterine activity, primary
    dysfunctional labour
    • In multiparous women: CPD,
    PRELIMINERIES
    • Correction of dehydration and ketoacidosis by IV fluids in case of
    neglacted prolonged labour
    DEFINITIVE TREATMENT
    FIRST STAGE DELAY
    IF only uterine activity is suboptimal,
    • Amniotomy/ oxytocin infusion
    • Effective pain relief

    SECONDARY ARREST
    • Careful use of oxytocin
    • Cesarean section delivery
    SECOND STAGE DELAY
    • Short period of expectant management is reasonable provided the
    FHR is reassuring and vaginal delivery is eminent
    • Otherwise, appropriate assisted delivery , vaginal or abdominal
    should be done.
    • Difficult instrumental delivery should be avoided.

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