From the Guidelines
The key management for prolonged active labor is to first rule out cephalopelvic disproportion (CPD) and then consider oxytocin augmentation, with the goal of achieving vaginal delivery if feasible, or proceeding to cesarean delivery (CD) if necessary, as evidenced by recent studies 1.
Key Considerations
- Before initiating management, it is crucial to assess for CPD, fetal malpresentation, and ensure adequate fetal monitoring, as CPD is a significant concern in prolonged active labor, with 40% to 50% of parturients with arrest of the active phase having concomitant CPD 1.
- Oxytocin augmentation can be considered, starting at a low dose and increasing as needed, with the goal of achieving adequate contractions and progress in cervical dilatation, as recent evidence suggests that 2 hours of oxytocin therapy is a safer threshold for assessing progress 1.
- Amniotomy (artificial rupture of membranes) can be performed if membranes are intact, but its effectiveness in promoting labor progress is not well-established, and it should not be relied upon as the sole intervention 1.
- Continuous fetal heart rate monitoring is essential during augmentation, and regular cervical examinations every 2 hours help assess progress, with expected dilation of at least 1 cm per hour during active labor.
Management Approach
- If CPD is suspected or cannot be ruled out, CD is a more prudent and safer choice, as the risks of damage to the mother and fetus are significant, and vaginal delivery is unlikely to be achievable or safe 1.
- In the absence of CPD, oxytocin augmentation can be continued, with careful monitoring of fetal and maternal well-being, and consideration of CD if no progress occurs after 2-4 hours of adequate contractions 1.
- The management approach should be individualized, taking into account factors such as maternal diabetes and obesity, pelvic shape and size, fetal macrosomia, malposition, and malpresentation, as these can increase the risk of complications and influence the decision to proceed with CD 1.
From the FDA Drug Label
In the management of prolonged active labor, oxytocin may be used for stimulation or reinforcement of labor, as in selected cases of uterine inertia The key management for prolonged active labor is stimulation or reinforcement of labor using oxytocin, as in selected cases of utine inertia 2.
- Oxytocin can be used to achieve early vaginal delivery for fetal or maternal reasons.
- It is essential to monitor and manage utine contractions to avoid complications such as tumultuous labor, uterine rupture, and fetal hypoxia 2.