Prolonged labour

1. INTRODUCTION

Prolonged labour (also called failure to progress) is a condition where labor lasts longer than normal duration, leading to increased risk for both mother and baby.

It is a common obstetric complication requiring timely intervention.

2. DEFINITION

Labour lasting > 18 hours (general definition)

OR

Slow progress in cervical dilatation and fetal descent beyond normal limits.

3. CAUSES (3 Ps)

1. Power (Uterine Contractions)

• Weak or ineffective contractions

• Incoordinate uterine action

2. Passenger (Fetus)

• Large baby (macrosomia)

• Malpresentation (breech, transverse lie)

• Fetal abnormalities

3. Passage (Pelvis)

• Narrow or contracted pelvis

• Pelvic abnormalities

4. CLINICAL MANIFESTATIONS

• Labour lasting too long

• Slow cervical dilatation

• Delayed descent of fetus

• Maternal exhaustion

• Dehydration

• Increased pain and distress

  
  

5. COMPLICATIONS

Maternal Complications

• Exhaustion and dehydration

• Infection (due to prolonged labor)

• Uterine rupture

• Postpartum haemorrhage (PPH)

• Trauma to birth canal

Fetal Complications

• Fetal distress

• Birth asphyxia

• Infection

• Fetal death (in severe cases)

6. MANAGEMENT

A. General Management

• Admit and monitor labor (partograph)

• Assess maternal and fetal condition

• Provide fluids and nutrition

• Pain relief

B. Specific Management (Based on Cause)

1. Power Problem

• Augmentation with oxytocin

• Amniotomy (rupture of membranes)

2. Passenger Problem

• Correct malpresentation if possible

• Assisted delivery or cesarean section

3. Passage Problem

• Cesarean section if pelvis inadequate

C. Monitoring

• Continuous fetal heart rate monitoring

• Cervical dilatation charting

• Vital signs of mother

D. nursing management

• Provide emotional support

• Monitor vitals and contractions

• Maintain hydration

• Prepare for emergency intervention

7. PREVENTION

• Regular antenatal care

• Early detection of risk factors

• Proper monitoring during labor

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🚀Here’s a short “exam trick” version for Prolonged labour— super quick points you can remember :

Definition: Labour lasting >18 hours or slow progress.

Cause: Problem with 3 Ps – Power, Passenger, Passage.

Power: Weak or ineffective uterine contractions.

Passenger: Large baby or malpresentation.

Passage: Narrow or abnormal pelvis.

Features: Slow dilatation, delayed fetal descent.

Maternal risks: Exhaustion, infection, PPH, uterine rupture.

Fetal risks: Distress, asphyxia, infection.

Diagnosis: Based on prolonged duration + poor progress.

Management: Monitor (partograph) + treat cause.

Treatment: Oxytocin, assisted delivery, or C-section.

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🚀Here’s a set of 07 MCQs on Prolonged Labour for practice

1. Prolonged labour is defined as labour lasting more than:

A. 12 hours

B. 16 hours

C. 18 hours

D. 24 hours

✅ Answer: C

2. Causes of prolonged labour are commonly grouped as:

A. 2 Ts

B. 3 Ps

C. 4 Ts

D. 5 Ps

✅ Answer: B

3. “Power” in prolonged labour refers to:

A. Fetal size

B. Pelvic structure

C. Uterine contractions

D. Placenta

✅ Answer: C

4. Which of the following is a “Passenger” problem?

A. Weak contractions

B. Narrow pelvis

C. Large baby

D. Cervical tear

✅ Answer: C

5. A maternal complication of prolonged labour is:

A. Hypertension

B. Uterine rupture

C. Diabetes

D. Asthma

✅ Answer: B

6. Fetal complication of prolonged labour:

A. Macrosomia

B. Fetal distress

C. Jaundice

D. Anemia

✅ Answer: B

7. Management of prolonged labour may include:

A. Antibiotics only

B. Bed rest only

C. Oxytocin or cesarean section

D. No treatment needed

✅ Answer: C