DEFINITION

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 cervix.
• Others - Injudicious early administration of sedatives and analgesics before the actual active labor begins.

DANGERS OF PROLONGED LABOUR

FOETAL

The foetal risk is increased due to the combined effects of:

1. Hypoxia
2. Intrauterine infection
3. Intracranial stress or bleeding following prolonged stay in the penineum and/or supermoulding of the head
4. Increased operative delivery.

MATERNAL

There is increased incidence of :

• Distress
• 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
• Increased operative delivery
• Puerperal sepsis
• Subinvolution.

The sum effects of all these lead to increased maternal morbidity and also increased maternal deaths.

TREATMENT

PREVENTIVE

• Antenatal or early intracranial detection of the factors likely to produce prolonged labor and then to institute its appropriate management.
• 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.