gynecology and obstetrics
Protracted Labor
Key Points
Protracted labor may result from fetopelvic disproportion or from uterine contractions that are too weak or infrequent or, occasionally, too strong or close together. Assess fetal and pelvic dimensions and fetal position, and evaluate contractions by palpating the uterus or using an intrauterine pressure catheter. If the 1st or 2nd stage of labor proceeds too slowly and fetal weight is acceptably low, augment labor withoxytocin; if treatment is unsuccessful, the cause may be fetal disproportion or intractable hypotonic dysfunction, possibly requiring cesarean delivery. If the 2nd stage of labor is prolonged, consider forceps or vacuum extraction if appropriate after evaluating the fetus's size, position, and station and the maternal pelvis. For hypertonic uterine dysfunction, consider repositioning, short-acting tocolytics, discontinuation ofoxytocinif it is being used, and analgesics. 