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Abnormal Labor Workup

  • Author: Saju Joy, MD, MS; Chief Editor: Thomas Chih Cheng Peng, MD  more...
 
Updated: Dec 30, 2015
 

Laboratory Studies

No specific laboratory studies are used to assess abnormal labor.

Other tests

The simplest test used to evaluate abnormal labor is to plot the patient's labor progress (cervical dilation vs duration in hours) on a labor curve.

A second test used to address adequate labor is the review of the uterine contraction pattern by determining adequacy of contractions with use of an intrauterine pressure catheter.

Most importantly, the fetal heart tracing must be reassuring throughout the labor course.

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Procedures

Clinical pelvimetry, at a minimum, must address the angles of the spinous processes (convergent, divergent, straight), the bi-ischial diameter (>8 cm), the distance to the sacral promontory from the symphysis pubis (>12 cm), and the relation of the bony pelvis to the fetal head.

Clinical pelvimetry requires experience and deliberate attention to the question of pelvic adequacy. It cannot account for fetal size or strength/frequency of contractions, but, in experienced hands, it may reliably identify a pelvis as adequate, borderline, or contracted.

An estimate of the fetal weight must be documented in the hospital chart early in the labor course. If concern for macrosomia exists, this must be addressed with the patient and the labor/delivery team in order to anticipate and prepare for labor dystocia.

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Contributor Information and Disclosures
Author

Saju Joy, MD, MS Associate Director, Division Chief of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Carolinas Medical Center

Saju Joy, MD, MS is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, Society for Maternal-Fetal Medicine, American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Deborah Lyon, MD Director, Division of Gynecology, Associate Professor, Department of Obstetrics and Gynecology, University of Florida Health Science Center at Jacksonville

Deborah Lyon, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Association of American Medical Colleges, Association of Professors of Gynecology and Obstetrics, Florida Medical Association

Disclosure: Nothing to disclose.

Patricia L Scott, MD Fellow in Maternal-Fetal Medicine, Wake Forest University, Bowman Gray School of Medicine

Patricia L Scott, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine, Tennessee Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

John G Pierce, Jr, MD Associate Professor, Departments of Obstetrics/Gynecology and Internal Medicine, Medical College of Virginia at Virginia Commonwealth University

John G Pierce, Jr, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Association of Professors of Gynecology and Obstetrics, Christian Medical and Dental Associations, Medical Society of Virginia, Society of Laparoendoscopic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Thomas Chih Cheng Peng, MD Professor (Collateral), Department Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine, VCU Health System

Thomas Chih Cheng Peng, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, Society for Maternal-Fetal Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Robert K Zurawin, MD Associate Professor, Chief, Section of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine

Robert K Zurawin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine, Association of Professors of Gynecology and Obstetrics, Central Association of Obstetricians and Gynecologists, Society of Laparoendoscopic Surgeons, Texas Medical Association, AAGL, Harris County Medical Society, North American Society for Pediatric and Adolescent Gynecology

Disclosure: Received consulting fee from Ethicon for consulting; Received consulting fee from Bayer for consulting; Received consulting fee from Hologic for consulting.

References
  1. Friedman EA. Primigravid labor; a graphicostatistical analysis. Obstet Gynecol. 1955 Dec. 6(6):567-89. [Medline].

  2. Zhang J, Troendle JF, Yancey MK. Reassessing the labor curve in nulliparous women. Am J Obstet Gynecol. 2002 Oct. 187(4):824-8. [Medline].

  3. Rouse DJ, Owen J, Hauth JC. Criteria for failed labor induction: prospective evaluation of a standardized protocol. Obstet Gynecol. 2000 Nov. 96(5 Pt 1):671-7. [Medline].

  4. Cheng YW, Hopkins LM, Caughey AB. How long is too long: Does a prolonged second stage of labor in nulliparous women affect maternal and neonatal outcomes?. Am J Obstet Gynecol. 2004 Sep. 191(3):933-8. [Medline].

  5. Rinehart BK, Terrone DA, Hudson C, Isler CM, Larmon JE, Perry KG Jr. Lack of utility of standard labor curves in the prediction of progression during labor induction. Am J Obstet Gynecol. 2000 Jun. 182(6):1520-6. [Medline].

  6. El-Sayed YY. Diagnosis and management of arrest disorders: duration to wait. Semin Perinatol. 2012 Oct. 36(5):374-8. [Medline].

  7. Zhang J, Landy HJ, Branch DW, et al. Contemporary patterns of spontaneous labor with normal neonatal outcomes. Obstet Gynecol. 2010 Dec. 116(6):1281-7. [Medline]. [Full Text].

  8. Allen VM, Baskett TF, O'Connell CM, McKeen D, Allen AC. Maternal and perinatal outcomes with increasing duration of the second stage of labor. Obstet Gynecol. 2009 Jun. 113(6):1248-58. [Medline].

  9. Cunningham FG, Leveno KL, Bloom SL, et al. Abnormal labor. Williams Obstetrics. 22nd ed. Appleton & Lange; 2007. 415-434.

  10. Anim-Somuah M, Smyth R, Howell C. Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev. 2005 Oct 19. CD000331. [Medline].

  11. Zuo Z, Goel S, Carter JE. Association of cervical cytology and HPV DNA status during pregnancy with placental abnormalities and preterm birth. Am J Clin Pathol. 2011 Aug. 136(2):260-5. [Medline].

  12. Gabbe SJ, O'Brien WF, Cefalo RC. Labor and delivery. Obstetrics: Normal and Problem Pregnancies. 5th ed. 2007. 322-326.

  13. Sanchez-Ramos L, Quillen MJ, Kaunitz AM. Randomized trial of oxytocin alone and with propranolol in the management of dysfunctional labor. Obstet Gynecol. 1996 Oct. 88(4 Pt 1):517-20. [Medline].

  14. Mitrani A, Oettinger M, Abinader EG, Sharf M, Klein A. Use of propranolol in dysfunctional labour. Br J Obstet Gynaecol. 1975 Aug. 82(8):651-5. [Medline].

  15. Cheng YW, Kaimal AJ, Snowden JM, Nicholson JM, Caughey AB. Induction of labor compared to expectant management in low-risk women and associated perinatal outcomes. Am J Obstet Gynecol. 2012 Dec. 207(6):502.e1-8. [Medline].

  16. Smyth RM, Alldred SK, Markham C. Amniotomy for shortening spontaneous labour. Cochrane Database Syst Rev. 2007 Oct 17. CD006167. [Medline].

  17. Mollberg M, Hagberg H, Bager B, Lilja H, Ladfors L. Risk factors for obstetric brachial plexus palsy among neonates delivered by vacuum extraction. Obstet Gynecol. 2005 Nov. 106(5 Pt 1):913-8. [Medline].

  18. Mehta SH, Bujold E, Blackwell SC, Sorokin Y, Sokol RJ. Is abnormal labor associated with shoulder dystocia in nulliparous women?. Am J Obstet Gynecol. 2004 Jun. 190(6):1604-7; discussion 1607-9. [Medline].

  19. Shields SG, Ratcliffe SD, Fontaine P, Leeman L. Dystocia in nulliparous women. Am Fam Physician. 2007 Jun 1. 75(11):1671-8. [Medline].

  20. Oppenheimer LW, Labrecque M, Wells G, et al. Prostaglandin E vaginal gel to treat dystocia in spontaneous labour: a multicentre randomised placebo-controlled trial. BJOG. 2005 May. 112(5):612-8. [Medline].

  21. Butchart AG, Mathews M, Surendran A. Complex regional pain syndrome following protracted labour*. Anaesthesia. 2012 Nov. 67(11):1272-4. [Medline].

  22. Treacy A, Robson M, O'Herlihy C. Dystocia increases with advancing maternal age. Am J Obstet Gynecol. 2006 Sep. 195(3):760-3. [Medline].

  23. Zhu BP, Grigorescu V, Le T, et al. Labor dystocia and its association with interpregnancy interval. Am J Obstet Gynecol. 2006 Jul. 195(1):121-8. [Medline].

  24. Cheng YW, Hopkins LM, Laros RK Jr, Caughey AB. Duration of the second stage of labor in multiparous women: maternal and neonatal outcomes. Am J Obstet Gynecol. 2007 Jun. 196(6):585.e1-6. [Medline].

  25. Friedman EA. Labor in multiparas; a graphicostatistical analysis. Obstet Gynecol. 1956 Dec. 8(6):691-703. [Medline].

  26. Hoffman MK, Vahratian A, Sciscione AC, Troendle JF, Zhang J. Comparison of labor progression between induced and noninduced multiparous women. Obstet Gynecol. 2006 May. 107(5):1029-34. [Medline].

  27. Vahratian A, Hoffman MK, Troendle JF, Zhang J. The impact of parity on course of labor in a contemporary population. Birth. 2006 Mar. 33(1):12-7. [Medline].

  28. Wood S, Ross S, Sauve R. Cesarean section and subsequent stillbirth, is confounding by indication responsible for the apparent association? An updated cohort analysis of a large perinatal database. PLoS One. 2015. 10(9):e0136272. [Medline].

  29. Chaiworapongsa T, Romero R, Whitten AE, et al. The use of angiogenic biomarkers in maternal blood to identify which SGA fetuses will require a preterm delivery and mothers who will develop pre-eclampsia. J Matern Fetal Neonatal Med. 2015 Aug 25. 1-15. [Medline].

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Labor curve for nulliparas.
Labor curve for nulliparas versus multiparas.
Abnormal labor curve.
Average labor curves by parity in singleton term pregnancies with spontaneous onset of labor. Reprinted from Seminars in Perinatology, Vol 36(5), El-Sayed YY, Diagnosis and Management of Arrest Disorders: Duration to Wait, pgs 374-8, Oct 2012, with permission from Elsevier.
The 95th percentiles of cumulative duration of labor from admission among singleton term nulliparous women with spontaneous onset of labor, vaginal delivery, and normal neonatal outcomes. Reprinted from Seminars in Perinatology, Vol 36(5), El-Sayed YY, Diagnosis and Management of Arrest Disorders: Duration to Wait, pgs 374-8, Oct 2012, with permission from Elsevier.
Table. Abnormal Labor Indicators
IndicationNulliparaMultipara
Prolonged latent phase>20 h>14 h
Average second stage50 min20 min
Prolonged second stage without (with) epidural>2 h (>3 h)>1 h (>2 h)
Protracted dilation< 1.2 cm/h< 1.5 cm/h
Protracted descent< 1 cm/h< 2 cm/h
Arrest of dilation*>2 h>2 h
Arrest of descent*>2 h>1 h
Prolonged third stage>30 min>30 min
*Adequate contractions >200 Montevideo units [MVU] per 10 minutes for 2 hours. (Please refer to the Pathophysiology for information regarding adequate contractions.)
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