Obstetrics Chapter 27: Prolonged Labor

What constitutes prolonged labor in terms of time?

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

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

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

Which factor does NOT contribute to a prolonged latent phase?

What is the preferred method for augmenting labor?

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

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

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

All of the following may contribute to prolonged labor EXCEPT:

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.

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.