Prolonged Labour

Prolonged labor is defined as the time between the first and second stages of labor. Last for more than 12 hours excluding fake labor. The duration of labor is calculated based on the mother's subjective estimation of the start of actual labor. Prolonged labor occurs when the presenting part remains high or lowers slowly during a good contraction and dilation of the cervix is delayed.

The practice of active management and labor augmentation has been utilized to reduce labor time and consequently dangers.

Prior to adopting extended labor. We must become acquainted with normal labor. The initial stage of regular labor is separated into two stages.

1. Latent phase
   It is also known as a sluggish period, and it is characterized by cervical dilatation ranging from 0 to 4 cm. The uterus contracts on a regular basis, causing the mother discomfort and suffering. The cervix gradually stretches and thins, a process known as effacement. The duration of the latent period varies depending on the individual and the parity. In nulliparous women, the latent phase lasted 6-8 hours.

   Prolonged latent phase: This occurs when the cervix is not dilated beyond 4cm after 8 hours of consistent contractions. The latent phase is still poorly understood, and defining its duration is challenging. When the mother is in false labor, a protracted latent phase may be diagnosed incorrectly.

2. Active phase

   It is the shorter duration of cervical dilatation ranging from 4 to 10 cm. In the active phase, the rate of dilatation should be at least 1cm/hr.

   Slow progress can be defined as a total time of hours or as the cervix fails to dilate at a specified pace each hour. A combination of elements, including the cervix, uterus, fetus, and mother's pelvis, causes a prolonged active phase.

Causes of Prolonged Labor

Fault in the power:

1. Abnormal uterine action
2. Hypotonic uterine dysfunction
3. Hypertonic uterine dysfunction
4. Incoordinate uterine action
5. Colicky uterus
6. Asymmetrical uterine contraction
7. Hyperactive lower segment
8. Constriction ring
9. Generalized tonic contraction
10. Cervical dystocia
11. Over efficient uterine action
12. Tonic uterine contraction and retraction
13. Precipitate labor

Fault in the passage:

1. Contracted pelvis
2. CPD
3. Pelvic tumor
4. Congenital abnormalities of the vagina
5. Rigid perineum
6. Even full bladder

Fault in passenger

1. Malposition: occipital posterior position
2. Malpresentation: face, brow, shoulder, and compound presentation
3. Fetal macrosomia or big baby
4. Fetal malformation

Others

1. Psychological causes
2. Judicious administration of sedative and analgesics before active labor begin.

Signs and Symptoms

1. Labor lasts more than 18 hours.
2. A patient appears tired and disturbed. Dehydration is possible. Due to prolonged mouth breathing, the mouth may get dry.
3. Pain may be felt more in the back and sides of the body, radiating to the thighs, rather than in the abdomen from the uterus. This is due to prolonged and severe pressure on the back muscles and ligaments.
4. Labor pains can be intense, frequent, and prolonged at first, but they will gradually fade and become extremely light as the muscles weary.
5. Because of dehydration, weariness, and stress, the pulse rate is frequently elevated.
6. The large intestines are dilated and can be palpated as enormous, thick structures filled with air along both sides of the uterus. When tapped, they provide the hollow sound of drums.
7. The uterus feels painful to the touch and may not fully relax between contractions.
8. Ketosis can develop as a result of prolonged fasting.
9. Fetal distress may occur.
10. Membranes can break early or late. If adequate antibiotics are not administered during early rupture, there is a danger of infection of the uterine contents.

Risks of Prolonged Labour

• Fetal distress is caused by a lack of oxygen reaching the fetus.
• Intracranial hemorrhage is defined as bleeding within the fetal head.
• Increased likelihood of operational delivery, such as Cesarian sections.
• Long-term risks of cerebral palsy in the newborn
• Maternal Dangers:
• Infections within the uterus
• Trauma includes injuries in the maternal birth canal, such as vulvar hematomas, perineal tears, cervical tears, and vaginal wall tears.
• Hemorrhage after childbirth.
• Infection after childbirth.
• Prolonged Labor Management and Treatment

Prolonged labor is currently uncommon due to the discovery of numerous medications capable of speeding labor.

• The cervix should dilate at a rate of 1cm per hour after 3cms of dilatation (that is, after the latent phase). If there is no dilation for an extended period of time, an oxytocin drip is initiated.
• Drugs such as epidotic cause cervical tissue softening. If the cervix does not dilate despite enough uterine contraction, epidotic or buscopan can be given safely to soften the cervix.
• Every hour, the pulse, blood pressure, and fetal heart sound (FHS) should be recorded, and the cervix should be dilatable every two hours. If necessary, FHS should be tested even more regularly.
• If despite the following procedures, labor does not progress or fetal distress develops, a Cesarean section should be performed.