 More than one pacemaker may be initiating

contractions or receptor points in the

myometrium may be acting independently of
the pacemaker.

 It May occur so closely together that they do

not allow good cotyledon filling.
 Applyfetal & uterine external monitor.
 Assessing rate, resting tone and fetal
response at least 15 minutes.

Oxytocin- helpful to stimulate more effective

and consistent pattern of contractions with
a better, lower resting tone.
Lengths of Phases and Stages of Normal Labor in Hours
Nullipara Multipara

Phase Average Upper Normal Average Upper Normal

Latent Phase 8.6 20.0 5.3 14.0

Active Phase 5.8 12.0 2.5 6.0

Second Stage 1 1.5 0.25 No limit

 Labor Disorders
Pattern Diagnostic Criterion

Nulliparas 20 hr or more Multiparas

Prolonged latent phase
14 hr or more

Protracted active phase dilatation Nulliparas 1.2 cm/hr or less

Nulliparas 1 cm/hr or less

Protracted descent
Multiparas 2 cm/hr or less
Nulliparas 3 hr or more Multiparas 1
Prolonged deceleration phase
hr or more

Secondary arrest of dilatation Arrest 2 hr or more

Arrest of descent Arrest 1 hr or more

No descent in deceleration phase of

Failure of descent
second stage
 Latent phase labor is considered abnormal, if it
lasts longer than:

1. 20 hours in a woman having her first baby.

2. More than 14 hours in women who have

already had a baby in the past.

Etiology:
 This may occur if the cervix is not “ripe” at
the beginning of labor and time must be
spent getting truly ready for labor.

 It may occur if there is excessive use of an

analgesic early in labor.

Outcome:
– 14% will go into a Protracted Active
Phase.
Management:

 Rest
 Ambulation
 Hydration
 Analgesia (narcotics such as Demerol 50-
100 mg IM, Morphine 7.5-15 mg IM, 
Dilaudid 1-2 mg IM, etc.)
 Oxytocin stimulation
 Amniotomy
This phase is prolonged if cervical dilatation
does not occur at rate of at least:

 1.2 cm/hr in nullipara.

 1.5 cm/hr in multipara.
Etiology:

 Inefficient uterine contractions.

 An unfavorable presentation or position of
the baby.
 A small pelvis.
 Improperly anesthesia

Outcome:
– 39% Po & 13% P1+ will go into
Secondary Arrest.
 Conservative management.
 Active intervention with oxytocin.
The phase is prolonged when it extends
beyond:

 3 hours in nullipara.
 1 hour in multipara.
Etiology:
 Abnormal fetal head position

A caesarian birth is often required.

Occurs if:
 There is no progress in cervical dilatation for more
than 2 hours.
Cervix becomes edematous. Can occur at 4-7 cm
dilatation or as a protracted Deceleration phase.
 Outcome
– Will require LSCS. If protracted deceleration beware
of shoulder impaction.
Occurs if:

 The rate of descent is less than 1.0 cm/hour

in nullipara or,
 2.0 cm/hour in a multipara.
 Contractions have been good quality and
proper duration, and effacement and
beginning dilatation have occurred, but
then contractions become infrequent and
of poor quality and dilatation stops.
 If everything is normal except for the
suddenly faulty contractions, rest and fluid
intake, as advocated for hypertonic
contractions also apply.
 IV oxytocin may be used to induced to the
uterus to contract.
 Semi-Fowlers position, suatting, kneeling, or
more pushing may speed descent.
 failure of the presenting fetal part to continue to
descend during the second stage of labor despite
uterine contractions and maternal effort.
Results when no descent has occurred for:
 1 hour in multipara, or
 2 hours in nullipara.

Etiology:
 Cephalopelvic Disproportion (CPD)
 Insufficient maternal effort
 Caesarian birth is usually necessary.

 If there are no contradiction to vaginal birth,

oxytocin may be used to assist labor.
 Fatigue and anxiety r/t prolonged labor.

 Risk for deficient fluid volume r/t length and

work of labor.