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1. PROLONGED LABOUR
Hassan, MD

2. 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.

3. 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

4. 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

5. PROLONGED FIRST STAGE OF LABOUR
Active management of labour
Indications
•Accurate diagnosis of Labour
•Primigravidae
•Singleton fetus
•Vertex presentation
•No evidence of fetal distress

6. 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

7. 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).

8. 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

9. 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

10. 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.

11. 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.

12. 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 (?)

13. 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

14. 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

15. 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

16. 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.vAmpicilin & metronidazole,
ceftriaxone
•Deliver the mother by CS

17. 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