PRESENTATION ON PROLONGED LABOR

AND ITS COMPLICATIONS BY

MISS RITA MAUNGER (CHN, RM, Bsc,
Midwifery)
Labor is the process by which there is effective uterine contractions along with
dilation of the cervix to expel the products of conception such as fetus, liquor,
membranes and placenta.

Prolong labor is defined as the process by which there is slow progression

either the first stage or second stage. Labor can be prolonged in a nulliparous
woman within 20 hours exceeds or 14 hours in a multiparous woman. In active
labor, the first stage is considered prolonged when the cervix dilates less than 1cm
per hour in a nulliparous woman and less 1.2 to 1.5cm in a multiparous woman.
 INCIDENCE
According to synthesis of the evidence on physiology of labor progression,
prolonged labor occurs in 10-15/19-20 of births. Prolonged labor and particularly its
overdiagnosis, thereby seems to contribute strongly to the rising global caesarean
section rates, which are forecast to reach 28.5% of all births by 2030.

CAUSES OF PROLONG LABOUR

1. Slow head descent in active phase in the first stage
2. Cervical dilation of less than 1cm in the active phase in the first stage of
labour
3. Malpresentation of the fetus such as brow, face, mentum, compound
4. Hydrocephalus
5. Cephalopelvic disproportion CPD
6. Ineffective uterine contractions, cervical dystocia /stenosis.

RISK FACTOR OF PROLONG LABOUR

1. Multiple gestation
2. Fibroids
3. Small stature
4. Old maternal age over the ages of 35
5. First time pregnancy (Primiparity).
 MANAGEMENT
1. Artificial rupture of membranes (AROM) and noting the colour of the liquor.
2. Setting of Intravenous Infusion.
3. Checking of vital signs.
4. Checking the fetal heart rate every 15 minutes.
5. Checking of contractions every 30 minutes to note its intensity.
6. Encouraging the mother to lie on her left side.
7. Taking a warm bath or shower.
8. Labor augmentation.

COMPLICATIONS
1. Infection
2. Postpartum hemorrhage
3. Future pelvic organ prolapsed leading to incontinence
4. Uterine rupture (very rare)
5. Fetal distress
6. Perinatal asphyxia
7. Shoulder dystocia leading to erb’s palsy.