Excessively prolonged active or pushing phase of labour. The term “prolonged labour” applies only at or after 5 cm dilation and 3 contractions per 10 minutes. Before that point, it is a “false labour” or prolonged latent phase.
Prolonged labour can be due to foeto-pelvic disproportion (mechanical dystocia) and/or inadequate contractions (dynamic dystocia) and/or ineffective maternal pushing efforts in the second stage of labour.
The main risks of prolonged labour are obstruction (Section 7.2) and foetal distress.
– Arrest of cervical dilation for 4 hours during the active phase
– Protracted foetal engagement or descent after more than 2 hours of complete dilation in a multipara and 3 hours of complete dilation in a primipara
See algorithms below.
For general patient care during labour, see Chapter 5, Section 5.1.4.
– Oxytocin is contra-indicated in case of frank foeto-pelvic disproportion (risk of uterine rupture).
– In the event of foetal distress (baseline < 100/minute or deceleration > 5 minutes or repetitive decelerations after contraction for a period > 30 minutes)1 and if the foetus is viable:
• At complete dilation, with the presenting part engaged: instrumental delivery (Chapter 5, Section 5.6);
• Prior to complete dilation, or at complete dilation with presenting part not engaged: consider caesarean section earlier than in the algorithms, but the context needs to be taken into account when deciding a caesarean section for exclusive foetal indication (Chapter 6, Section 6.4).
In either case, do not use—or stop, if already using—oxytocin.
– If the foetus is dead, avoid caesarean section whenever possible. Allow more time for dilation and engagement. Consider embryotomy (Chapter 9, Section 9.7).
Management of arrest of cervical dilation for 4 hours during the active phase
Management of protracted foetal engagement or descent after more than 2 hours of complete dilation in a multipara and 3 hours of complete dilation in a primipara
For other presentations (breech shoulder, chin-posterior face, or brow presentations): caesarean section.
In case a cardiotocograph is used, abnormal variability can also indicate foetal distress. For more information, see FIGO Intrapartum Fetal Monitoring Guidelines