Review Question - QID 103463

This patient is experiencing prolongation of stage 1 active phase of labor. This woman's cervix is dilating at a rate less than 1.2 cm/hour for a primipara, which is indicative of prolongation of labor. The best step at this stage is to administer oxytocin given this woman's weak contractions as measured by the IUPC.

The most common cause of protracted or arrested dilation (stage 1) in the active phase of labor is hypotonic contractions. Additional causes include inadequate size and shape of the pelvis, excessive fetal size, and abnormal fetal position. Protracted dilation and labor arrest may result from hypotonic contractions that are very painful and appear like normal labor. They are only referred to as hypotonic as they are unable to propel the baby forward, not because they are less intense and/or painful. Treatment is induction with oxytocin with or without amniotomy.

Smith et al. reports that amniotomy is a useful procedure that could shorten labor, but could also lead to increased uterine contractions as well as infection, umbilical cord prolapse and fetal laceration. They further conclude that position changes promote patient comfort and efficiency during labor, and that pharmacologic methods of analgesia are effective but pose various risks.

Macones et al. showed in a randomized controlled trial that amniotomy shortens the time to delivery by over 2 hours. These improvements in labor outcomes did not result in increased complications. Overall they concluded that early amniotomy is a safe and efficacious adjunct in labor inductions.

Incorrect Answers:
Answer 1: While intracervical prostaglandins (e.g. cervadil) help in ripening the cervix, it is not the best intervention as the cervix is already at 5 cm and would likely not be further dilated with prostaglandins (best used at 0-1 cm).
Answer 3: Cesarian section would be indicated if this patient failed to progress after sufficient contractions have been documented.
Answer 4: Administering morphine would be the correct answer if the IUPC demonstrated HYPERtonic contractions.
Answer 5: Observation would only prolong labor as this patient is clearly not progressing appropriately.