Definition:- Labour is called prolonged when the combined duration of first and second stage is more than 18 hours.
Labour is considered prolonged when cervical dialation rate is less than 1cm/hr.
Cause:-
a. First Stage:- Failure to dilate cervix
-Fault in power (abnormal uterine contraction)
-Fault in passage (contracted pelvis)
-Fault in passenger.
-Other (injudious admn. of analgesic)
b. Second Stage:-
-non descend of presenting part is due to failure in power( inability in bearing down, uterine inertia, epidural analgesia, constriction ring), fault in passage , fault in passenger.
Diagnosis:- prolonged labour has not diagnosis but it can be manifestated as abnormal. The cause of this prolonged labour can be detected by abdominal and vaginal examination.
First Stage:- first stage is considered prolonged when duration is more than 12 hrs. The rate of cervical dilatation is less than 1cm/hr in a primi and less than 1.5cm/hr in multi.
Second stage :- second stage is considered as prolonged when it is more than 2hrs in primi and more than 1hr in multi.
Diagnosis features are :-
Sluggish descending of presenting part
Variable degrees of moulding and caput formation in cephalic presentation.
Management:-
Prevention:- Antenatal or early intra-natal detection of the factors which produce prolonged labour.
Use of partograph, help early detection.
Selective and judicious augmentation of labour.
Change of posture in labour other than supine to increase uterine contraction
When progress is slow attempt should be made to determine the cause before deciding on management for insufficient uterine action is to encourage ambulation to produce normal activity.
The upright position for mother improve the application of the presenting part on to the cervix,this would make the contractions less painful but stronger and more efficient.
Adequate analgesic should be given to mother.
All observation are to be recorded on partogram.
The mother should be encouraged to empty the bladder about 2hrly.
Feotal Heart rate should be monitored.
Jishu Baiju
