Failure to Progress
(Unsatisfactory Progress of Labor)
Failure to progress is when apparently effective labor does not lead to delivery of the baby. This happens in spite of medical interventions. The cervix may not dilate and efface. Effacement is a thinning of the cervix in preparation for delivery. Failure-to-progress can also happen if the baby does not move down the birth canal.
Fetal Descent Stations (Birth Presentation)
Some labors will stall without a clear cause. Uterine contractions can become ineffective, widely spaced or both. This can happen despite the best efforts of a laboring woman and those who support her.
Risk factors for failure to progress include:
- A large baby
- History of failure to progress in a previous labor
- A "tired" uterus that has undertaken multiple pregnancies
The active phase of labor is defined by:
- A cervix that has opened to 3-4 centimeters
- An advanced thinning of the cervix known as effacement
- Less than three contractions in ten minutes, lasting less than 40 seconds each
- Less than one centimeter change per hour for two hours in a row
- No change in the baby’s station after three hours of pushing if the cervix is fully dilated (10 cm)
Failure to progress will not be diagnosed until after the active phase of labor has been achieved.
Your doctor may insert a monitor into your uterus. The monitor is a small catheter with a device to measure the contractions. This will get more accurate information about the quality and strength of your contractions. The monitor can count how many there are, how long they last, and how much time goes by between each one.
Your doctor will talk with you about the best plan.
Rupture of Membranes
Your doctor may break your water artificially using a tool made for that purpose.
If you have not had any pain relieving drugs, and are in pain, your doctor may suggest that you consider pain treatment. An example of pain treatment is an epidural]]> . An epidural numbs the abdomen and legs.
]]>Oxytocin]]> is a natural stimulant of the uterine muscle. It is sometimes used to help achieve adequate labor.
There is no known way to prevent failure to progress in labor. It can be detected early and managed by the following:
- Confirm active labor before making a diagnosis
- Perform amniotomy (inserted monitor) early in labor
- Conduct frequent cervical checks
- Augment labor with oxytocin to induce strong regular contractions
American Congress of Obstetricians and Gynecologists
American Pregnancy Association
National Guideline Clearinghouse
The Society of Obstetricians and Gynaecologists of Canada
Women's Health Matters
Prevention, diagnosis and treatment of failure to progress in obstetrical labor. National Guideline Clearinghouse website. Available at: http://www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=5991 . Accessed August 7, 2005.
Last reviewed January 2010 by ]]>Ganson Purcell Jr., MD, FACOG, FACPE]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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