Causes and diagnostic criteria for prolonged labor

Posted by Master, Doctor Vu Thi Hong Chinh - Obstetrics Department - Vinmec Times City International Hospital

Giving birth is a wonderful experience for every woman, uterine contractions are the basic driving force that helps push the baby out of the uterus. The average time of labor is about 12 to 18 hours, sometimes quicker. Labor can be determined according to the stage of labor, progress of cervical dilation is appropriate for labor or not.

Prolonged labor is labor for some reason your baby is not born after 20 hours of actual labor, some experts say this is 24 hours or the active phase over 7 hours. If you are pregnant with twins, the time will count as 16 hours. In this case, the physician must prescribe medication or surgical intervention or cesarean section.
There are many causes of prolonged labor, but the most common are 3 groups of causes:
On the mother's side:
Pelvic abnormalities: limited pelvis, narrow pelvis, pelvic deviation... Systemic diseases: Tuberculosis, pre-eclampsia, heart disease.. Tumors in the pelvis obstructing the outflow of the fetus: uterine fibroids, ovarian tumors (prostate tumors)... Cervical non-progression . Disorders of uterine contractions: weak, fast, irregular Mother pushing weakly Mother has little tolerance, mother pushes weakly, has a scar on the uterus (old caesarean scar, fibroid removal scar...)

On the fetal side:
Big fetus (estimated from 3500 grams or more for the baby, from 4000 grams for the straw). Abnormal pregnancy: hydrocephalus, toad abdomen... Abnormal positions: horizontal, frontal, posterior chin. On the fetal side:
Placenta praevia , placental abruption. Premature rupture of membranes, premature rupture of membranes. Short vegetable string...

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Diagnosis of prolonged labor is based on the 2002 WHO labor chart or when 1 or more of the following symptoms are present:
Active phase labor, lasting more than 7 hours, transition to active phase. The cervix stops growing. Examination revealed no progress of the perforation of the fetal position. There are signs of craniosynostosis, serous tumor. Fetal failure, uterine contraction disorder...

Prolonged labor increases the risk of cesarean section and can lead to the following serious complications and sequelae:
Fetal failure in labor. Threatened uterine rupture - uterine rupture. Genital tract trauma: bladder, rectum.. Postpartum bleeding. Neonatal infections, postpartum infections.

When a prolonged labor is diagnosed, the doctor must have an urgent and positive attitude to give appropriate treatment indications for each specific cause:
Assess the uterine contractions to be sufficient and appropriate. Is it suitable for the stage of labor? Sometimes reducing pain, resting, changing positions will help pregnant women relax, which will help the labor progress better. Closely monitor the fetal heart because of the risk of fetal distress. Find the cause of prolonged labor and treat it according to the cause. Intervention: Provide appropriate management indications for each specific cause.
Large fetus or suspected asymmetry of the fetus and pelvis: Do the crown test. Uterine contractions disorder, cervix does not progress: Oxytocin infusion if uterine contractions are weak, give anticonvulsant if contractions. strength contraction. Fetal failure: fetal cardiopulmonary resuscitation. Closely monitor labor with labor charts, evaluate the effectiveness of management.

4.1. Indications for cesarean section are indicated in the following cases: Abnormal position, failed test Hypertensive uterine contractions The cervix is ​​fully dilated, the head has not reached, the pregnancy is impaired. The cervix is ​​fully dilated > 1 h of the first hour, not at risk. uterine rupture when the cervix is ​​not fully dilated 4.2. Indications for lower-line forceps cesarean section when: Threatened uterine rupture, cervix is ​​fully dilated, head is low, cervix is ​​fully dilated, fetus is weak or mother pushes weakly, head is low, protracted labor is labor requiring labor. However, the doctor needs to make reasonable and timely decisions because too early intervention will increase the rate of surgical intervention or cesarean section. On the contrary, if it is too late, there is a risk of complications for the mother and the child.

At Vinmec International General Hospital, there is a package maternity service as a solution to help pregnant women feel secure because of the companionship of the medical team throughout the pregnancy. When choosing Maternity Package, pregnant women can:
The pregnancy process is monitored by a team of qualified doctors Regular check-up, early detection of abnormalities Maternity package helps to facilitate the process. childbirth process Newborns receive comprehensive care Recommended video:


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