From the Guidelines
The top 10 most common risk factors for prolonged and obstructed labor include maternal obesity, advanced maternal age, fetal macrosomia, malpresentation, cephalopelvic disproportion, hypocontractile uterus, premature rupture of membranes, epidural anesthesia, dehydration, and psychological factors such as anxiety or fear, as identified in recent studies 1.
Risk Factors for Prolonged and Obstructed Labor
The following are the key risk factors associated with prolonged and obstructed labor:
- Maternal obesity, which increases the risk due to excessive soft tissue obstruction and poor uterine contractility 1
- Advanced maternal age (typically over 35 years), associated with decreased uterine muscle efficiency 1
- Fetal macrosomia, where the baby weighs over 4000g, can cause mechanical obstruction 1
- Malpresentation, particularly occiput posterior or transverse positions, increases labor difficulty 1
- Cephalopelvic disproportion, which occurs when the fetal head is too large for the maternal pelvis 1
- Hypocontractile uterus or uterine fatigue, leading to ineffective contractions, often requiring oxytocin augmentation 1
- Premature rupture of membranes, which can initiate labor before the body is fully ready 1
- Epidural anesthesia, while providing pain relief, may reduce the urge to push and relax pelvic muscles 1
- Dehydration and electrolyte imbalances, which can impair uterine muscle function 1
- Psychological factors, such as extreme anxiety or fear, can increase catecholamine levels, inhibiting normal labor progression 1
Importance of Early Recognition and Intervention
Early recognition of these risk factors allows for appropriate interventions, including position changes, oxytocin augmentation, adequate hydration, and in some cases, timely cesarean delivery to prevent maternal and fetal complications 1. It is essential to identify and address these risk factors to minimize the risk of prolonged and obstructed labor, which can lead to severe maternal and fetal morbidity and mortality. Therefore, a thorough assessment of these risk factors is crucial in the management of labor, and timely intervention can significantly improve outcomes 1.
From the Research
Risk Factors for Prolonged and Obstructed Labor
The following are some of the most common risk factors for prolonged and obstructed labor:
- Uterine inactivity 2
- Obesity 2
- Cephalopelvic disproportion 2, 3, 4, 5
- Fetal malposition 2
- Macrosomia (fetal weight > 4500g) 3, 4, 6, 5
- Parity (number of previous births) 2, 3
- Regional anesthesia status 2
- Maternal age 3
- Term fundal height (measurement of the size of the uterus) 3
- Maternal height 3
- History of past macrosomia 3
- Gestational diabetes 4, 5
Additional Risk Factors
Other risk factors that may contribute to prolonged and obstructed labor include: