From the Guidelines
The most common risk factors for protraction and arrested labor disorders include cephalopelvic disproportion (CPD), fetal macrosomia, malposition, malpresentation, uterine overdistention, and unexplained insufficient uterine contractility, as well as maternal factors such as obesity, advanced age, and chorioamnionitis 1.
Key Risk Factors
- Cephalopelvic disproportion (CPD) is a major risk factor, occurring in 25% to 30% of cases with protracted active phase labor 1
- Fetal macrosomia, malposition, and malpresentation can also contribute to labor abnormalities 1
- Uterine overdistention, such as in multiple pregnancy or polyhydramnios, can lead to insufficient uterine contractility 1
- Maternal factors, including obesity, advanced age, and chorioamnionitis, can increase the risk of protraction and arrested labor disorders 1
Importance of Early Identification
Early identification of these risk factors during prenatal care and labor is crucial to implement appropriate interventions, such as oxytocin augmentation, adequate hydration, position changes, or timely consideration of cesarean delivery when necessary, to prevent maternal and fetal complications associated with prolonged labor 1.
Management and Intervention
A thorough cephalopelvimetric assessment is vital to exclude the presence of disproportion, and if evidence of CPD is found, cesarean delivery is a more prudent and safer choice 1. In cases where oxytocin infusion is used to enhance contractions, careful titration of the infusion rate is necessary to avoid uterine hyperstimulation 1. Regular monitoring of cervical dilatation and fetal well-being is essential to identify any potential complications early on 1.
From the Research
Risk Factors for Protraction and Arrest of Labor Disorders
The most common risk factors for protraction and arrest of labor disorders include:
Cephalopelvic Disproportion (CPD)
CPD occurs when there is a mismatch between the size of the fetal head and the size of the maternal pelvis, resulting in "failure to progress" in labor for mechanical reasons 3. Studies have shown that CPD is associated with an altered uterine contraction shape in the active phase of labor 4. Maternal height and neonatal birthweight are also important factors in the risk of CPD, with shorter mothers and higher neonatal birthweight increasing the risk of CPD 5.
Other Risk Factors
Other risk factors for protraction and arrest of labor disorders include: