Prolonged labor

• Distress to the fetus as a result of decreasing oxygen levels
• Internal bleeding of the fetus's head (intracranial hemorrhage)
• Higher chance of operative delivery
• Risks of long-term injuries to the infant such as hypoxic-ischemic encephalopathy (HIE) or cerebral palsy
• Infection of the uterus
• Damage to the birth canal
• Postpartum infection
• Postpartum hemorrhage

The term describes labor that occurs very slowly.[2] This does not necessarily mean that the woman or fetus's health is being compromised, but it is painful and is an important indication for doctors to pay attention to warning signs of prolonged labor.[2]

The phase of labor that extends into multiple hours (at least 14). The cervix usually dilates to over 4 cm before active labor occurs.[7] When it first begins, it is encouraged that women stand up, walk around, and eat or drink.[8] If failure to progress extends beyond this point, preventive measures need to be taken.

Fetal malpresentations are irregular positions of the crown of the fetal head in relation to the mother's pelvis (the fetus is in an abnormal position).[9] Some important ways to manage fetal malpresentation are making rapid evaluations of the condition of the women pertaining to vital signs as well as the heart rate of the fetus.[9] If fetal heart rate is abnormal, and if membranes have ruptured and amniotic fluid is atypical, it is important for medical professionals to determine the presenting part of the fetus and the position of the fetal head.[9] Possible delivery methods, if this is the case, are compound presentation, vaginal breech delivery, or caesarean section for breech presentation depending upon the severity of the malposition.[9]

This refers to uterine conditions that result in the uterus not having enough coordination or strength to dilate the cervix and push the baby through the birth canal. Issues with uterine contractions are the main cause of prolonged labor during the latent phase. Contractions may not occur as of a result of uterine tumors. In addition, if the uterus is stretched, usually due to previous pregnancies or multiple gestation, contractions may be difficult. Irregular or weak contractions can be fixed through stimulation of the uterus or oxytocin infusions. Lack of contractions may be caused by an overwhelming amount of painkillers or anesthesia, by which the medications should be discontinued. In this case, it is appropriate for assisted vaginal delivery to be conducted.

Cervical dystocia, or stenosis, occurs when the cervix fails to dilate after a practical amount of time during positive uterine pains. The main problems in cervical dystocia is the lack of uterine inertia and cervical abnormalities, which prevent the cervix from fully dilating.[10] It is very typical of patients that have hypopituitarism.[11] There are many preexisting complications that may result in stenosis. Common conditions that lead to stenosis are tumors, a full bladder, large size of the infant, multiple pregnancies, delay in rupture of membranes, or problems with the cervix.[11] High stress may interfere with the progression of pregnancy in cases such as these, leading to prolonged labor.[11]

Cephalopelvic disproportion is the issue that arises when the fetus' body or head is too large to pass through the woman’s pelvis.[12] Common conditions that lead to CPD are diabetes, multiple pregnancies, small or abnormally shaped pelvis, atypical fetal positions, hereditary factors, and first time pregnancies.[12] Medical professionals can usually estimate if fetal size is too large based on ultrasounds, but they are not always entirely accurate.[12] Doctors typically determine CPD when labor begins and the use of oxytocin is not effective. The safest way for delivery to take place when CPD is a factor is through Caesarean sections.[12]

There are two different methods of assisted vaginal delivery that medical professionals typically utilize to aid in delivery in order to avoid surgical methods of fetal extraction. These procedures are only applied if a vaginal delivery has proven to still be safe to the woman and the baby, based on their vital signs. Assisted vaginal delivery is usually only used in the latent phase.[5] Delivery during the active phase is usually associated with more complications for the woman.[5] One approach to assisted vaginal delivery is the use of forceps.[5] The forceps doctors use resemble two large salad spoons and are inserted into the cervix, around the baby's head and help to guide it out of the birth canal.[5] The other option is the use of vacuum extraction. Vacuums used have a cup on the end and are inserted into the cervix.[5] The cup attaches to the fetus's head by suction and aids in guiding delivery. The choice between forceps and vacuum extraction is usually made by the doctor based on preference. It is important that these methods are used properly, or else they can cause severe birth injuries to the baby that may be permanent.[5]

Caesarean sections, also referred to as C-sections, are usually quick solutions to the issue of failure to progress. Often, C-sections are the best options to avoid harming the fetus or the woman, especially if labor proves to be life-threatening. One third of C-sections occur as a result of prolonged labor.[1] C-sections are usually a necessary measure in prolonged labor to avoid serious birth complications. If the mother reaches the active phase of prolonged labor, a C-section is the safest solution. Caesarean sections need to be performed immediately if there are signs of fetal distress, uterine rupture, or cord prolapse. It is important that medical professionals are equipped and prepared in the case of an imperative C-section. There is a window of time by which Caesarean sections need to be executed if any warning signs present themselves. If there is a delay in the C-section, permanent damage can result to the baby, such as cerebral palsy or hypoxic-ischemic encephalopathy (HIE). Due to all the risk factors that are present in the event of prolonged labor, it is extremely important that medical teams are well-suited and prepared to conduct a C-section if needed.