PROLONGED LABOUR

AND OBSTRUCTED
LABOUR

COMPLICATIONS

What is
prolonged
labour?

PROLONGED LABOUR
Prolonged labour
onset of true labour
rhythmical painful
contractions accompanied
by cervical dilation
where labour is longer
than 24 hours

What are the

components of
prolonged
labour?

PROLONGED LABOUR
PROLONGED LABOUR
IS divided as
prolonged latent phase
of labour
prolonged active phase
of labour

What is
latent
phase?

LATENT PHASE
Latent phase

The onset of regular

painful
contractions
with cervical dilation

Dilatation of 0 -3 cm

The duration is 3 hours

PROLONGED LATENT
PHASE

0 to 3 cm cervical
dilatation is
longer than 8
hours

PROLONGED LATENT
PHASE
If the woman remains in the
latent phase of labour for more 8
hours, progress is not normal.
In these cases the woman may
be in
false labour or a
prolonged latent phase.

ACTIVE PHASE
ACTIVE PHASE:Acceleration phase
Primipara 4.9-11.7 hrs
multiparous 2.2-5.2 hrs
Deceleration Phase
Primipara54 min-3.3 hrs
Multiparaous 14 -53 min

SECOND STAGE
SECOND STAGE
Primpara 57 min-2.5
hrs
Multiparaous
18 -50
min

How to
differentiate
between false
labour and
prolonged

LATENT PHASE AND FALSE

LABOUR

In the latent phase there is

some change in cervical
effacement and/or dilatation
and contractions continue,
whereas in false labour there
is no change in the cervix
and contractions cease.

PROLONGED LATENT
PHASE
The diagnosis is usually made
retrospectively, either when
contractions cease in cases of
false labour, or
when cervical dilatation
progresses beyond
3 cm and
contractions continue.
Any woman with a latent phase
of 8 hours must be referred.

PROLONGED LATENT
PHASE
In a prolonged latent phase, the
cervical dilatation will remain
between 1 cm and 3 cm.
If using the partograph with the
latent phase, cervical dilatation
when plotted will cross to the
right of the alert line after 8
hours and then the woman
should be referred.

PROLONGED LATENT
PHASE

If she has not

entered the active
phase of labour after
8 hours of induction,
she should be
delivered by
caesarean section

What is
active phase
of labour?

ACTIVE PHASE OF
LABOUR
ACTIVE PHASE OF
LABOUR
phase with regular
painful contractions
Cervical dilatation from 4
cm 10 cm should not be
longer than 12 hours

How would
you manage
prolonged
active phase?

MANAGEMENT OF PROLONGED
ACTIVE PHASE

Assess uterine contractions:

If contractions are inefficient
(less than 3 contractions in
10 minutes, each lasting less
than 40 seconds),
inadequate uterine activity
augment with oxytocin

In Prolonged
active phase with
good uterine
contraction how
would you manage?

PROLONGED ACTIVE PHASECONTD

If contractions are efficient

suspect
cephalopelvic disproportion,
obstruction,
malposition
or malpresentation
LOOK FOR A CAUSE

What are the

causes of
prolonged
labour?

PROLONGED LABOUR

Causes of prolonged labour

It is usual to describe this as due to
the
three "Ps":
Powers: poor or uncoordinated uterine
action
Passenger: fetal head too large ,mal
position and deflexion of the head
Passage: smaller, tumour or
obstruction in pelvis, cervical dystocia

What is
obstructed
labour?

OBSTRUCTED LABOUR
Obstructed labour means in spite of
strong contractions of the uterus
the fetus cannot descend through the
pelvis
Obstruction usually occurs at the
pelvic brim, but occasionally it may
occur in the midcavity or at the outlet
of the pelvis
Labour will not progress without
assistance

OBSTRUCTED LABOURCONTD
Causes of obstructed labour:
cephalopelvic disproportion
(small pelvis or large fetus)
abnormal presentations, e.g.
brow, shoulder, aftercoming
head in breech presentation
Malposition occipitoposterior,
mentoposterior

OBSTRUCTED LABOUR CONTD

fetal abnormalities, e.g.
hydrocephalus
abnormalities of the
reproductive tract, e.g.
pelvic tumour
stenosis of cervix
cervical dystocia

What will be the

partograph
findings in
obstructed
labour?

PARTOGRAPH RECORDINGS IN
OBSTRUCTED LABOUR
a prolonged first or second stage
of labour which is evident
because cervical dilatation will
cross first the alert line and
then,
if no action is taken, will cross the
action line despite a
history of
strong
uterine contractions.

Normal partograph- 1954

Prolonged latent phase

Prolonged active phase

2ry Arrest of cervical

dilatation

2ry arrest in descent of

head

Oxytocin infusion

What will be the

abdominal
examination
findings in
obstructed

OBSTRUCTED LABOUR
On abdominal
examination
Bandls ring
Good uterine
contraction
Presenting part is high

What is
Bandls
ring?

BANDLS RING
Bandls ring is the name given to the
area between the upper and lower
uterine segments when it becomes
visible and/or palpable during labour.
In the process of normal pregnancy
and labour, this area is called a
retraction ring.
It should not
normally be seen or felt on
abdominal examination

BANDLS RING
Bandls ring is a late sign of obstructed
labour. It can be seen as a depression
across the abdomen at about the level of
the umbilicus.
Above this is the grossly thickened,
retracted upper uterine segment.
Below the Bandls ring is the distended,
dangerously thinned lower uterine
segment.
The lower abdomen can be further
distended by a full bladder and bowel.

What will be
the vaginal
examination
findings in
obstructed

OBSTRUCTED LABOUR
FINDINGS
Vaginal examination
offensive meconium
oedema of the vulva,
especially if the woman has
been pushing for a long time
Vagina- hot and dry because
of dehydration

OBSTRUCTED LABOUR
-CONTD
oedema of the cervix
In case of outlet obstruction:
a large caput succedaneum can
be felt
Gross moulding
head , shoulder, brow or
posterior face stucked
Presentation or prolapsed arm.

What are the

grades of
moulding?

MOULDINGS
Moulding is recorded as follows:
bones are separated and the
sutures can
be felt easily (o)
bones are just touching each
other (+)
bones are overlapping but can
be separated (++)
bones are overlapping severely
and cannot be separated (+++).

What are the

causes of
cephalo pelvic
disproportion?

CEPHALOPELVIC
DISPROPORTION
Cephalopelvic
disproportion occurs when
there is a misfit
betweenthe fetal head
and the pelvis.
This means it is difficult
or impossible for the fetus
to pass safely through the

CPD
small pelvis with a
normal size head, or
a normal pelvis with a
large fetus, or
combination of a large
baby and small pelvis.

What is
borderline
(marginal)
pelvis?

Cephalopelvic disproportion may be:

(a)borderline:
In these cases the problem may be
overcome during labour. Strong
uterine contractions, relaxation of
the pelvic joints and moulding of the
fetal skull may enable the fetus to
pass through the pelvis for vaginal
delivery

What is
definite
CPD?

(b)Definite: This occurs

because the pelvis is too
small, is abnormal in
shape, or because the
fetus is abnormal or too
large for the pelvis
through which it has to
pass. Operative delivery

Therefore the
diagnosis of cephalopelvic disproportion
is after the trial of
labour

How to
diagnose
CPD?

DIAGNOSIS OF CEPHALOPELVIC
DISPROPORTION
Secondary arrest of cervical
dilatation
Lack of descent of presenting part
large caput,
third degree moulding,
Cervix fully dilated and woman has
urge to push, but there is no
descent. Prolonged expulsive
phase

How to
diagnose
CPD in
labour?

CPD- FEATURES IN
LABOUR
cervix poorly applied to
presenting part,
oedematous cervix,
ballooning of lower uterine
segment,
formation of Bandls ring,
maternal and fetal distress.

How to detect
poor progress
of labour?

DIAGNOSIS OF UNSATISFACTORY
PROGRESS OF LABOUR

Cervix not dilated beyond 4

cm after 8 hours in spite of
regular uterine contractionsProlonged latent phase
Cervical dilatation to the
right of the alert line on the
partograph

What are the

predisposing
factors for
rupture of uterus?

Danger of uterine
rupture
When the membranes rupture and the
amniotic fluid drains
the fetus is forced into the lower
segment of the uterus by contractions
If the contractions continue, the lower
segment stretches, becomes
dangerously thin and is likely to
rupture
NEVER add oxytocin without excluding
obstruction

RUPTURE OF THE
UTERUS
may be complete or incomplete.
If it is complete (i.e.
the uterus communicates directly
with the peritoneal cavity), bleeding
will occur within the peritoneum.
If it is incomplete (i.e. the rupture
does not reach the visceral
peritoneum), bleeding will occur
behind the visceral peritoneumdiagnosis is difficult

RUPTURE OF THE
UTERUS
is more likely to occur
in multipara
Especially in high
parous mothers
scar of a previous
caesarean section

What are the

complications
of prolonged
labour?

PROLONGED AND OBSTRUCTED

LABOUR

Maternal and fetal distress

Infection, septcaemia
Potpartum haemorrhage
Fistula formation ischaemic
necrosis
Genital tract prolapse
Psychological trauma