From the Guidelines
Prolonged active first stage of labor is defined as an excessively slow rate of dilatation in the active phase, with a rate of less than 0.6 cm/h, as shown in the most recent study by Friedman et al. 1. This definition is crucial in identifying abnormal labor patterns and managing them safely. The active phase of labor begins when the rate of dilatation increases from the latent phase to a more rapid slope, and it ends with the apparent slowing of dilatation, a deceleration phase 1. Several factors can contribute to a prolonged active phase, including cephalopelvic disproportion, excessive neuraxial block, poor uterine contractility, fetal malpositions, and maternal obesity 1. The diagnosis of protracted active phase can be made by observing the rate of cervical dilatation, which should be at least 1 cm/h for nulliparous women and 1.5 cm/h for multiparas, as confirmed by diverse clinical investigators and objective instrumental measuring methods 1. Key points to consider in the management of prolonged active first stage of labor include:
- Assessing for potential causes of prolonged labor, such as inadequate contractions or cephalopelvic disproportion
- Augmenting contractions with oxytocin (Pitocin) if necessary, starting at 1-2 mU/min and increasing by 1-2 mU/min every 30-60 minutes until adequate contractions are achieved
- Considering adequate hydration, position changes, and pain management
- Evaluating the need for cesarean delivery if no progress occurs despite 4 hours of adequate contractions. It is essential to recognize and manage prolonged labor promptly to minimize the risks of maternal infection, postpartum hemorrhage, and fetal distress, as highlighted in the study by Friedman et al. 1.