Obstetrics Chapter 27: Prolonged Labor

Questions and Answers

What constitutes prolonged labor in terms of time?

The combined duration of the first and second stage is more than 18 hours. (correct)

The cervix must dilate at a rate of less than 0.5 cm/h.

The combined duration of the first and second stage is more than 12 hours.

Labor must last longer than 10 hours in any stage.

Which of the following is NOT a possible cause of prolonged labor?

Pelvic or fetal factors

Inefficient uterine contractions

Advanced maternal age (correct)

Protracted cervical dilatation

During the first stage of labor, the cervical dilatation rate is considered prolonged if it is less than how many cm/h?

2 cm/h

3 cm/h

0.5 cm/h

1 cm/h (correct)

What is the normal duration of the latent phase in a primigravida?

About 8 hours Signup and view all the answers

Which factor does NOT contribute to a prolonged latent phase?

Spontaneous labor onset Signup and view all the answers

What is the preferred method for augmenting labor?

Oxytocin or prostaglandins Signup and view all the answers

Which of the following is NOT considered a cause of failure to dilate the cervix in the first stage of labor?

Pelvic floor resistance Signup and view all the answers

Which condition is likely to cause non-descent of the presenting part during the second stage of labor?

Cephalopelvic disproportion Signup and view all the answers

What is an example of a fault in the 'passenger' during labor?

Malpresentation of the fetus Signup and view all the answers

All of the following may contribute to prolonged labor EXCEPT:

Diligent administration of analgesics Signup and view all the answers

Study Notes

Prolonged Labor

Defined as the combined duration of the first and second stages exceeding 18 hours.
Characterized by protracted cervical dilatation and/or inadequate descent of the presenting part.
Prolonged labor is identified when the cervical dilatation rate is less than 1 cm/h for a minimum of 4 hours.
Not synonymous with inefficient uterine contractions; these can be a contributing factor.

Prolonged Latent Phase

The preparatory phase before actual labor onset; averages 8 hours for primigravidae and 4 hours for multiparae.
Considered abnormal if exceeding 20 hours in primigravidae and 14 hours in multiparae.
Causes include unripe cervix, malpresentation, cephalopelvic disproportion, premature rupture of membranes, induction of labor, and early regional anesthesia onset.
Generally managed with expectant care unless there are indications for expediting delivery.
Rest and analgesics recommended; augmentation typically involves medical methods, avoiding amniotomy.
Prolonged latent phase is not an indication for cesarean delivery.

Causes of Prolonged Labor

Factors affecting the first stage include:
- Fault in power: uterine inertia or incoordinate contractions.
- Fault in passage: contracted pelvis, cervical dystocia, pelvic tumors, or full bladder.
- Fault in passenger: malposition (occipito posterior) and malpresentation (face, brow), congenital fetal anomalies.
In the second stage, sluggish descent can result from:
- Fault in power: uterine inertia, inability to bear down, regional anesthetics affecting contractions, or constriction ring.
- Fault in passage: cephalopelvic disproportion, contracted pelvis, spasm or scarring of pelvic floor/perineum, or soft tissue tumors.
Poor administration of sedatives and analgesics before active labor can also lead to non-dilatation of the cervix.

Description

This quiz focuses on the definition and implications of prolonged labor in obstetrics. It highlights the criteria for determining when labor is considered prolonged, specifically examining the significance of cervical dilation and duration. Explore key concepts and clinical relevance related to this critical aspect of childbirth.