- Prolonged Labor: Labor lasting longer than normal due to inefficient uterine contractions, fetal malposition, or cephalopelvic disproportion (CPD).
- Obstructed Labor: Labor that fails to progress despite strong uterine contractions due to mechanical obstruction (Pelvic or Fetal causes).
Classification of Prolonged Labor
|
Stage of Labor |
Prolonged If |
|
First Stage (Latent Phase) |
>8 hours |
|
First Stage (Active Phase) |
Cervical dilation <1 cm/hour (Primigravida),
<1.5 cm/hour (Multigravida) |
|
Second Stage |
>2 hours (Primigravida), >1 hour
(Multigravida) |
|
Third Stage |
>30 minutes |
Causes of Prolonged & Obstructed Labor
1. Passenger (Fetal Causes)
- Cephalopelvic Disproportion (CPD) → Head too large for pelvis.
- Malpresentations:
- Breech, Face, Brow Presentation.
- Transverse Lie (Shoulder Presentation).
- Fetal Macrosomia (Weight >4 kg).
2. Passage (Pelvic Causes)
- Contracted pelvis (Rickets, Malnutrition).
- Pelvic Tumors (Fibroids, Ovarian mass).
3. Power (Uterine Causes)
- Ineffective uterine contractions (Uterine inertia).
- Hypertonic contractions (Tetanic contractions).
Clinical Features of Obstructed Labor
- Failure of labor progress despite strong contractions.
- Bandl’s Ring Formation (Pathological Retraction Ring).
- Fetal Distress (Abnormal FHR, Meconium-stained liquor).
- Maternal Exhaustion, Dehydration, Ketosis.
- Bladder Distension & Hematuria (Impending rupture).
Complications of Obstructed Labor
Maternal Complications:
- Ruptured Uterus.
- Postpartum Hemorrhage (PPH).
- Sepsis (Puerperal Sepsis, Chorioamnionitis).
- Vesicovaginal & Rectovaginal Fistula (Prolonged pressure on bladder/rectum).
Fetal Complications:
- Birth Asphyxia.
- Stillbirth or Neonatal Death.
- Brachial Plexus Injury (Erb’s Palsy).
Diagnosis of Obstructed Labor
1. Clinical Examination:
- Cervical Dilation: No progress despite strong contractions.
- Abdominal Signs:
- Bandl’s Ring (Upper uterine segment stretched, Lower segment thinned).
- Bladder distension & Suprapubic tenderness.
2. Fetal Monitoring:
- Non-reassuring CTG (Fetal Bradycardia, Late Decelerations).
3. Imaging:
- Ultrasound (To rule out CPD, Fetal Malposition).
Management of Prolonged & Obstructed Labor
1. Prolonged Labor (Not yet Obstructed)
- Monitor Progress using Partograph.
- Augmentation with Oxytocin (If contractions weak).
- Artificial Rupture of Membranes (ARM) if necessary.
2. Obstructed Labor (Confirmed)
- Immediate Cesarean Section (Definitive treatment).
- IV Fluids, Foley Catheter to drain bladder.
- Antibiotics if infection suspected.
Prevention of Obstructed Labor
- Antenatal Pelvic Assessment for CPD.
- Early detection of labor complications using Partograph.
- Timely referral & Cesarean section in high-risk cases.
Summary Table: Prolonged vs. Obstructed Labor
|
Feature |
Prolonged Labor |
Obstructed Labor |
|
Definition |
Labor taking longer than expected |
Labor that fails to progress despite
strong contractions |
|
Causes |
Weak contractions, CPD, Malposition |
Mechanical obstruction (CPD, Tumors) |
|
Signs |
Slow cervical dilation |
Bandl’s Ring, Severe pain, Fetal distress |
|
Complications |
Maternal exhaustion, Fetal distress |
Uterine rupture, Fistula, Stillbirth |
|
Management |
Oxytocin, Monitoring |
Immediate C-section |
Key Takeaways
- Prolonged labor may be managed with Oxytocin if contractions are weak.
- Obstructed labor is an emergency requiring immediate C-section.
- Bandl’s Ring & Bladder Distension are warning signs of impending rupture.
- Early diagnosis & referral can prevent maternal & fetal complications.
