From the Guidelines
Fetal presentations most associated with arrested labor include occiput posterior position, brow presentation, face presentation, and asynclitism, as these presentations can lead to mechanical obstacles to descent, rotation, or flexion, thereby increasing the risk of labor arrest and potential complications. According to a recent study published in the American Journal of Obstetrics and Gynecology 1, the frequency of cephalopelvic disproportion (CPD) in association with a prolonged deceleration phase is considerably greater than with a protracted active phase, highlighting the importance of thorough cephalopelvimetric assessment before pursuing oxytocin infusion or undertaking a difficult vaginal operative delivery. Key factors that signal concern for arrested labor include:
- Maternal diabetes and obesity
- Pelvic shape and size
- Fetal macrosomia
- Malposition (occiput posterior and transverse)
- Malpresentation (brow)
- Asynclitism
- Excess molding These factors can increase the risk of labor arrest and should be carefully evaluated to determine the best course of management. In cases where evidence of CPD is found or cannot be ruled out with a reasonable degree of certainty, cesarean delivery (CD) is a more prudent and safer choice, as the risks of damage to the mother and fetus are significant 1. Early recognition of abnormal fetal presentations and careful assessment of potential risk factors are essential for appropriate management and prevention of maternal and fetal complications from prolonged labor.
From the Research
Fetal Presentations Associated with Arrested Labor
- Breech presentation is commonly associated with arrested labor, with a prevalence of 3-4% of singleton fetuses presenting breech at delivery 2
- Transverse presentation is also a type of malpresentation that can lead to arrested labor, and it requires careful management to avoid complications 3, 4
- Other types of malpresentations, such as face, brow, and compound presentations, can also contribute to arrested labor 4
Risk Factors for Arrested Labor in Breech Presentation
- Footling presentation, hyperextended head, and estimated fetal weight of <2500 g or >4000 g are associated with a higher risk of adverse fetal outcome in vaginal breech delivery 5
- Prolonged labor and lack of experienced clinician at vaginal breech birth can also increase the risk of arrested labor 5
- Maternal factors, such as multiparity, previously affected pregnancy, polyhydramnios, and fetal and uterine anomalies, can also contribute to the risk of arrested labor in breech presentation 4
Management of Fetal Malpresentation
- External cephalic version is a technique that can be used to manage breech presentation and reduce the need for cesarean delivery 4, 6
- Vaginal breech delivery can be a safe option for women who meet certain criteria, such as frank breech presentation, estimated fetal weight of 2500-3500 g, and adequate pelvimetry 2, 5
- Cesarean section is often recommended for women with breech presentation who do not meet these criteria or who have other risk factors for arrested labor 2, 3, 5