From the Guidelines
Failure to progress in labor is defined as a situation where labor does not advance as expected despite adequate contractions, occurring when cervical dilation stops for at least 2 hours during the active phase of labor or when there is insufficient descent of the fetus through the birth canal. This condition may be diagnosed when the first stage of labor exceeds 20 hours for first-time mothers or 14 hours for those who have given birth before. The active phase of labor begins at various degrees of dilatation when the rate of dilatation transitions from the relatively flat slope of the latent phase to a more rapid slope, as noted in a study published in the American Journal of Obstetrics and Gynecology 1.
Key Factors
- The definition of failure to progress is crucial for distinguishing between normal labor variations and true failure to progress, as premature intervention can lead to unnecessary cesarean deliveries while delayed intervention may increase risks to both mother and baby.
- Common causes of failure to progress include ineffective contractions, fetal malpositioning (especially occiput posterior position), cephalopelvic disproportion (when the baby's head is too large for the mother's pelvis), or maternal exhaustion.
- Management typically begins with interventions like position changes, ambulation, or amniotomy (breaking the water), followed by oxytocin augmentation to strengthen contractions, as discussed in a recent study 1.
- If these measures fail, cesarean delivery may be necessary, particularly if there is evidence of cephalopelvic disproportion or other complications.
Diagnosis and Management
- The diagnosis of failure to progress requires careful evaluation of the patient's labor progress, including serial measurements of cervical dilatation and fetal descent.
- A study published in the American Journal of Obstetrics and Gynecology provides a recommended evidence-based sequence for the diagnosis and management of a protracted active phase, including the evaluation of factors associated with the labor disorder 1.
- The management of failure to progress should be individualized based on the patient's specific circumstances, including the presence of any underlying medical conditions or complications.
Importance of Accurate Diagnosis
- Accurate diagnosis of failure to progress is essential to prevent unnecessary interventions and minimize risks to both mother and baby.
- A study published in the American Journal of Obstetrics and Gynecology highlights the importance of careful evaluation and management of labor disorders, including failure to progress 1.
From the Research
Definition of Failure to Progress (FTP) in Labor
- Failure to progress (FTP) in labor is a condition where the labor process is not advancing as expected, and the cervin is not dilating or the fetus is not descending into the birth canal at a normal rate 2.
- According to recent guidelines, labor arrest should not be diagnosed unless ≥6 cm cervical dilatation has been reached or labor has been stimulated for at ≥6 hours 2.
- The definition of FTP is crucial in determining the need for intervention, such as cesarean delivery, and in assessing the progress of labor 3, 4.
Key Factors in Defining FTP
- Cervical dilatation: ≥6 cm is considered a critical threshold for diagnosing labor arrest 2.
- Labor stimulation: ≥6 hours of labor stimulation is considered a critical threshold for diagnosing labor arrest 2.
- Uterine contractions: the effects of individual uterine contractions on cervical dilatation and fetal head descent can vary during labor 5.
Clinical Implications
- Accurate assessment of labor progress is essential to reduce uncertainty and improve outcomes 3, 4.
- The adoption of new labor assessment guidelines should be based on thorough evaluation of their risks and benefits 4.
- Existing studies have shown that application of new guidelines may result in a modest fall in cesarean delivery rate, but may also be accompanied by significant increases in maternal and neonatal morbidity 4.