Obstetrics and gynecology Obstetrics

Prolonged Stages of Labor

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2 أقسام

Summary

سجل دخولك لإضافة ملاحظات خاصة لكل قسم  · اشترك الآن

Stages of Labor

Etiology: Abnormalities of the 3 P's of Labor

  • Pelvis: Size and shape of the maternal pelvis, such as a small bony pelvis.
  • Passenger: Size and position of the infant, including fetal macrosomia or abnormal orientation.
  • Power: Strength and frequency of contractions, like dysfunctional contractions.

 

Stage
 Characteristics

 Duration Management
Nulliparouspatients
 Multiparouspatients
First stage of labor Prolonged latent phase
  • Slow progression (contraction frequency) with a cervical dilation≤ 6 cm
  • > 20 hours
  • > 14 hours
  • Rest, hydration, and adequate analgesia
  • Oxytocin may be considered in well-rested mothers if the previous measures have been implemented.
  • Other: amniotomy, cervical ripening
Prolonged active phase
  • ≥ 6 cm cervical dilation without adequate dilation (< 1 cm/2h)
  • Usually due to abnormalities of the 3 P's of labor (pelvis, passenger, power)
  • Augmentation of labor with oxytocin for hypotonic contractions
  • Analgesia for hypertonic contractions
  • Amniotomy
  • Cesarean delivery if previous measures are ineffective
Arrested active phase
  • ≥ 6 cm cervical dilation with ruptured membranes and no cervical change after one of the following:
    • ≥ 4 hours of adequate contractions (≥ 200 Montevideo units)
    • > 6 hours of inadequate contractions
  • Usually due to abnormalities of the 3 P's of labor
  • Cesarean delivery
Prolonged second stage of labor
  • Arrest of fetal descent occurring after complete cervical dilation (> 10 cm) and effacement (100%)
  • Usually due to abnormalities of the 3 P's of labor
  • > 3 hours(> 4 hours in patients who received an epidural)
  • > 2 hours(> 3 hours in patients who received an epidural)
  • Augmentation of labor with oxytocin if uterine contractions are inadequate and progress is < 1 cm after 60–90 minutes of pushing
  • Trial of forceps or vacuum delivery if the fetal head is engaged and maternal contractions are adequate
  • Cesarean delivery if the fetal head is not engaged
Prolonged third stage of labor
  • Placenta has not been delivered 30 minutes after the birth
  • Inadequate contractions or retained placenta (e.g., abnormal placental implantation such as placenta increta, placenta percreta, placenta accreta)
  • Active management of the third stage of labor, e.g.:
    • Oxytocin
    • Controlled umbilical cord traction
  • Manual or surgical removal of the placenta
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الدرس التالي Assisted vaginal birth
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