When the combined duration of the first and
second stage of labour is more than the arbitrary time limit of 18 hours, it is
termed prolonged labor. The prolongation encompasses delayed dilatation of the
cervix (in the first stage) and/or inadequate descent of the presenting part (during the first or second stage).
Inefficient uterine contraction is one of the causes of prolonged labor, others
being either due to pelvis or the foetus. It must be borne in mind that
prolonged labor is not synonymous with inefficient uterine contraction.
CAUSES OF PROLONGED LABOR
Any one or combination of the basic elements
involved in labor are responsible, both in the First Stage - failure to dilate
the cervix and the Second Stage - Sluggish or non-descent of the foetus in the
second stage is due to
- Fault in power include Inability to bear
down, abnormal uterine contraction or in-coordinate uterine contraction.
- Fault in the passage includes - contracted
pelvis, pelvic tumor, eg: fibroid or even full baldder.
- Fault in the passenger includes -
malposition and malpresentation, congenital anomalies of the foetus
(hydrocephalus - common) Too often deflexed head, minor degrees of pelvic
contraction and disordered uterine action have got sinister effects in
causing non-dilatation of the
- Others - Injudicious early administration of
sedatives and analgesics before the actual active labor begins.
DANGERS OF PROLONGED LABOUR
The foetal risk is increased due to the combined effects
- Intrauterine infection
- Intracranial stress or bleeding following prolonged stay
in the penineum and/or supermoulding of the head
- Increased operative delivery.
There is increased incidence of :
- Postpartum haemorrhage
- Trauma to the genital tract - concealed (undue
stretching of the perineal muscles which may be the cause of prolapse at a later
period) or revealed such as cervical tear, rupture uterus
- Puerperal sepsis
The sum effects of all these lead to increased maternal morbidity and also
increased maternal deaths.
- Antenatal or early intracranial detection of
the factors likely to produce prolonged labor and then to institute its
- Selective and judicious augmentation of
labor by low rupture of the membranes followed by medication.
- Vigilant doctors during labor and facilities
for appropriate management should the need arise.