Failure to Progress

Abnormally slow or arrested cervical dilatation after the onset of true labour, despite adequate time and contractions.

Aetiology

Factor
Causes
Power
Inadequate uterine contractions, poor oxytocin response
Passenger
Macrosomia, malpresentation, malposition (OP, asynclitism)
Passage
Contracted pelvis, cephalopelvic disproportion (CPD)

Risk Factors

  • Nulliparity
  • Epidural analgesia
  • Advanced maternal age
  • Obesity
  • Fetal macrosomia
  • Malposition (occiput posterior)
  • Overdistended uterus (polyhydramnios, multiple pregnancy)

Clinical Assessment

Confirm True Labour

  • Regular painful contractions
  • Progressive cervical effacement and dilatation

Evaluate Progress

  • Partograph assessment
  • Cervical dilatation rate:
    • Expected ≥ 1 cm / 2 hours in active phase

Assess Uterine Activity

  • Adequate contractions:
    • ≥ 200 Montevideo units
    • 3–5 contractions / 10 minutes, lasting 40–60 seconds

Rule Out CPD

  • Clinical pelvimetry
  • Fetal size estimation
  • Station and moulding

Labour Curve

Classice “Friedman”

Labour Pattern
Diagnostic Criteria
Nulliparous
Multiparous
Prolonged Labour – Prolonged Latent Phase
Cervical dilatation 0–3 cm
> 20 hours
> 14 hours
Protracted Labour – Prolonged Active Phase
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• Protracted active phase dilatation
Cervical dilatation rate
< 1.2 cm/hour
< 1.5 cm/hour
• Protracted descent
Fetal head descent rate
< 1 cm/hour
< 2 cm/hour
Arrest Disorders / Failure to Progress (Arrest of Labour)
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• Secondary arrest of dilatation
No cervical dilatation
> 2 hours
> 2 hours
• Prolonged deceleration phase
Deceleration phase duration
> 3 hours
> 1 hour
• Arrest of descent
No fetal descent during maximal dilatation
> 1 hour
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• Failure of descent
No descent during deceleration phase or second stage of labour
—
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ACOG / WHO–Updated Diagnostic Criteria

Labour Pattern
Diagnostic Criteria
Nulliparous & Multiparous
Latent Phase (≤ 5 cm)
Prolonged duration
❌ No longer defined as abnormal
Active Phase (≥ 6 cm)
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Active Phase Protraction
Slow but ongoing cervical change
⚠️ No strict definition (individualized assessment)
Active Phase Arrest
≥ 6 cm dilatation, ruptured membranes, no cervical change despite:
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• ≥ 4 hours of adequate contractions
✔
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OR
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• ≥ 6 hours of inadequate contractions with oxytocin
✔
Arrest of Descent (Second Stage)
No descent despite adequate pushing
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Nulliparous
≥ 3 hours (≥ 4 h with epidural)
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Multiparous
≥ 2 hours (≥ 3 h with epidural)
Failure of Descent
Persistent lack of descent with adequate efforts
✔ Clinical diagnosis

Management

General Measures

  • Reassurance and psychological support
  • Hydration (oral/IV)
  • Adequate analgesia
  • Empty bladder regularly

Correct Reversible Causes

Cause
Management
Inadequate contractions
Amniotomy ± oxytocin
Dehydration / exhaustion
IV fluids, rest
Malposition (OP)
Maternal position change, manual rotation
Full bladder
Catheterization

Augmentation of Labour

Indications
  • Inadequate uterine contractions
  • No CPD
Methods
  • Amniotomy
  • Oxytocin infusion (titrated)
⚠️ Continuous fetal heart rate monitoring required.

Indications for Cesarean Section

  • Confirmed active phase arrest
  • Cephalopelvic disproportion
  • Failed augmentation
  • Fetal distress
  • Maternal exhaustion or infection

Complications of obstructed labour

Maternal

  • Prolonged labour
  • Chorioamnionitis
  • Uterine rupture
  • Postpartum hemorrhage

Fetal

  • Fetal distress
  • Birth asphyxia
  • Neonatal sepsis