Prolonged spontaneous labour in primigravidae whose labour was actively managed: results of an audit

Summary

The aim of this observational study was to examine prolonged spontaneous labour in primigravidae with a single, live fetus and cephalic presentation, more than 12 hours duration from the time of admission to the delivery unit to the birth of the baby. All labours were subject to active management as practised in this institution. The incidence of prolonged labour was 1.7 per cent (n = 158). Low cervical dilatation when the diagnosis of labour was made, prolonged pregnancy and increased birth weight (> 3499 g) were more common in prolonged labour than in primigravid labours of less than 12 hours duration. The most common association with prolonged labour was inefficient uterine action (78.5 per cent, n=124). Twenty-seven patients (17.1 per cent) had persistent occipito-posterior position and seven had cephalopelvic disproportion. There were no maternal deaths. Postpartum endometritis (10.8 per cent, n= 17) was the main maternal morbidity and was more common after caesar-ean sections. With prolonged labour, the forceps delivery rate was 43 per cent (n = 68) and the caesarean section rate 28-5 percent (n = 45). None of the caesarean sections were for fetal distress. There was one unexplained perinatal death. Thirty-two (20.2 per cent) of neonates were admitted to the neonatal unit but there was no case of neonatal seizures. Prolonged spontaneous labour in primigravidae continues to be associated with considerable maternal and neonatal morbidity.