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Prolonged Labor - Failure to Progress: Definition, Causes, Signs and symptoms, Diagnosis, Management, Complication and Prevention

prolonged_labor
Source: isabelrangel.net

    Definition

    The labor is said to be prolonged when the combined duration of the first and second stage is more than the arbitrary time limit of 18 hrs.

    Causes


    • Unripe cervix 
    • Malposition and malpresentation 
    • Cephalopelvic disproportion 
    • Premature rupture of the membranes 
    • Abnormal uterine contraction 
    • Contracted pelvis 
    • Congenital malformation of the baby

    Signs and symptoms


    • Labor extends for more than 18 hours.
    • Patient looks exhausted and distressed. Dehydration may be present. Mouth may be dry due to prolonged mouth breathing
    • Pain may be more at the back and sides of the body, radiating to the thighs rather than from the uterus in the abdomen. This is due to excessive and prolonged pressure over the muscles and ligaments of the back

    Diagnosis


    • Abdominal And Vaginal Examination. 
    • During vaginal examination, if a finger is accommodated in between the cervix and the head during uterine contraction pelvic adequacy can be reasonably established. 
    • Intranatal imaging (radiography, CT or MRI) is of help in determining the fetal station and position as well as pelvic shape and size.

    Management 


    • Rest and analgesic are usually given. When augmentation is decided, medical methods (oxytocin or prostaglandins) are preferred. 
    • Amniotomy is usually avoided. 
    • Prolonged latent phase is not an indication for cesarean delivery.

    Complication

    Maternal 

    • Maternal exhaustion
    • Increased incidence of CS 
    • Birth canal injuries if forceps is used 
    • PPH, Puerperal sepsis 

    Fetal 

    • Fetal distress, Chorioamnionitis, neonatal sepsis 
    • ICH-if forceps is used

    Prevention

    • Antenatal or early intra natal detection of the factors
    • likely to produce prolonged labor. 
    • Use of partograph
    • Selection and judicious augmentation of labor by low rupture of the membranes followed by oxytocin drip. 
    • Change of posture in labor, other than supine to increase uterine contractions, avoidance of dehydration in labor and use of adequate analgesia for pain relief.

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