Slow progress in labour

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Slow labour is a rate of <1cm/h after the latent phase. Prolonged labour is >12h after the latent phase.


  • Ineffective uterine action is the most common cause of slow progress in labour and happen almost exclusively in nulliparous women. In multiparous women, malpositions and malpresentations must be checked for carefully. It is managed using augmentation i.e. amniotomy with oxytocin.
  • Hyperactive uterine action is excessive, prolonged and frequent contractions. This can cause fetal distress and this distress indicates Caesarean section.


If you don't know the nomenclature for the different presentations, go here.


  • Breech presentations (where the baby's bum is the presenting part) is usually discovered before labour. It can be delivered vaginally or by Caesarean and about 50% are successfully delivered vaginally. It is more common in premature labour.
  • Transverse lie (where neither bum nor face but arms or back are the presenting part i.e. the foetus is lying transversely) is impossible to deliver vaginally. Elective Caesarean is indicated
  • External cephalic version (ECV) is an attempt to turn the baby from breech to cephalic presentation. Terbutaline is given to relax the uterine muscles and the obstetrician attempts to turn the baby. Foetal heart monitoring is done before, during and after the procedure and an ultrasound scan is done beforehand.


  • Occipito-posterior (OP) presentation occurs in 5% of deliveries and generally results in longer and more painful labour. Delivery is by flexion of the head the head, rather than extension, over the perineum and towards the abdomen. Instrumental delivery can turn the head round to face the right way.
  • Occipito-transverse (OT); needs to be manually rotated by instrumental delivery, either forceps or a Ventouse if the labour has already reached the second stage. Brow and Face presentations must be delivered by Caesarean section.