Abnormal Labor Clinical Presentation

Updated: Oct 07, 2022
  • Author: Nina S Olsen, MD; Chief Editor: Ronald M Ramus, MD  more...
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Evaluate every pregnant patient who presents with contractions in the labor and delivery unit. Any patient in labor is at risk for abnormal labor regardless of the number of previous pregnancies or the seemingly adequate dimensions of the pelvis. Plot the progress of any patient in labor, and evaluate it on a labor curve (see images below).

Labor curve for nulliparas. Labor curve for nulliparas.
Labor curve for nulliparas versus multiparas. Labor curve for nulliparas versus multiparas.

Physical Examination

Upon admission to the labor and delivery unit, determine and document clinical findings.

Clinical pelvimetry, which is best performed at the first prenatal care visit, is important in order to assess the pelvic type (eg, android, gynecoid, platypelloid, anthropoid). Evaluate the position of the fetal head in early labor because caput and moulding complicate correct assessment as labor progresses. Establish and document an estimated fetal weight. Monitor fetal heart rate and uterine contraction patterns to assess fetal well-being and adequacy of labor. Perform a cervical examination to determine whether the patient is in the latent or active phase of labor.

Addressing these issues allows for an assessment of the current phase of labor and anticipation of whether abnormal labor from any of the 3 P' s may be encountered.