Normal labour:

• Spontaneous expulsion, through the natural

passages (birth canal) of a single, mature (37-
42 completed weeks of pregnancy) alive
fetus, presenting by vertex, within a reasonable
time, without fetal or maternal complications.
• Labour becomes abnormal when there is poor
progress &/ the fetus shows signs of
compromise. Also, if there is fetal death
malpresentation , multiple gestation , uterine
scar , or if labour has been induced.
 Abnormal Labour
(Prolonged Labour)
 Dysfunctional labor
(Prolonged labour)
1-Prolonged 1st stage.
2-Prolonged 2 stage.
nd

Any deviation from normal progress of

labor , either in cervical dilatation or in
descent of the presenting part
this can be judged by partogram
WHO partogram
 Etiology
1.Abn.of power (uterine contraction & maternal
expulsive effort) Malfunction in the myogenic,
neurogenic, or hormonal mechanisms of uterine activity.
2.Abn.in the passenger (Malpresentation ,Malposition
,Macrosomia , fetal anomalies)
3-Abn.in the passeges (abn.of the bony pelvis i.e
CPD),abn.in the soft tissue of birth canal (uterine
malformation, pelvic tumors , fibroid , cervical dystocia).
4. Extrinsic factors: sedation, anxiety, anesthesia,
position.
 Patterns of abn.progress
in labour
1.Disorders of dilatation:
a. Prolonged latent phase
b. Protracted active phase (primary
dysfunctional labour)
c. Secondary arrest
2.Disorders of descent:
a. Failure of descent
b. Protracted descent
c. Arrest of descent.
 Prolonged Latent Phase Labor
If after 8hr from the onset of regular
contractions cervical dilatation still<4cm the
Dx. Of prolonged latent phase is made.
It is more common in primiparous women
 Primary dysfunctional labour
– Active phase:
• cervical dilation rate at least 1cm/hr.

• (Protracted Active Phase)

– it means poor progress in the active phase of
labour (<2cm dilatation/4hr)
– More common in primiparous commonly caused
by inefficient uterine contractions, but can also
result from CPD& malposition of the fetus.
 Secondary arrest
Arrest: occurs when progress in the
active phase of 1st stage is initially good
but then slows ,or stops altogether ,
typically after 7cm ( 2 hours with no
cervical change)
Although inefficient contractions may be
the cause , fetal malpositions ,
malpresentations & CPD are more
common.
Arrest of Active Labor
Cervical dilatation
(cm)
Types of dysfunctional

Time (hours)
 Prolonged second stage
• Max. duration of 2nd stage for nullips: 2hr
Max. duration for multips: 1hr

• Abnormal progress of labour may occur either due to

slow descent or secondary arrest of descent or failure
of descent of fetal head.
 Management of prolonged
labour
1-Careful history
2-Asses and examine the woman to identify the
cause and to determine the maternal and foetal
conditions, include: general , abdomen( asses the
contraction ,lie, presentation of fetus, size, fetal
heart assessment)
The pelvic examination ( assessment of bony
pelvis, soft tissue, progress of labour, meconium).
Treatment of prolonged labour
Either allow the labour to continue
OR
Undertake an operative delivery
Allowing the labour to continue
1- in the absence of fetal distress
2- in the absence of maternal distress
3- no severe cephalopelvic disproportion

BY
Rupturing of membrane
If ineffecient contraction (oxytocin)2m
unit/min ,
Adequate analgesia ,Good maternal fluid
balance
If no progress after 4hr C/S
2- operative delivery if there is:
Fetal distress
Maternal distress
Frank cephalopelvic disproportion
Arrest or slow cervical dilatation in spite
of good uterine contraction for 4 hr
Operative delivery either by caesarean
section, or by ventouse extraction or
forceps delivery.
 Obstructed labour
Arrest of cervical dilatation or descent of
presenting part inspite of good uterine
contraction with large caput, severe
moulding, cervix poorly applied to presenting
part, oedematous cervix, ballooning of lower
uterine segment, formation of retraction ring,
maternal & fetal distress

Obstruction
 Causes
1-Maternal:
Contraction or deformity of bony pelvis
Pelvic tumors: fibroid,ovarian tumor, Pelvic
kidney
Abnormalities of uterus or vagina
Stenosis of cervix or vagina
2- Fetal:
- Large fetus
- Malposition or malpresentatio
- Congenital abnormalities of fetus
:Hydrocephalus , fetal ascitis ,hydrops faetalis
,conjoined twin
 Treatment
rehydration
antibiotics
emergency caesarean section
Complications of Obstructed
Labor
• Maternal complications :
– Intrapartum infection–
especially in the setting of ROM
– Uterine rupture– esp with prior
C/S
– Fistula formation
– Pelvic floor injury