Abstract
Aim: To develop clinical algorithms for the assessment and management of slow progress of labour.
Population: Low-risk singleton, term, pregnant women in labour.
Setting : Institutional births in low- and middle-income countries.
Search Strategy: We systematically reviewed the literature on normal labour progression, and guidance on clinical management of abnormally slow progression from 1 December 2015 to 1 December 2020 from relevant international guidelines, Cochrane reviews and primary research studies in PubMed by searching for international and national guidance documents, electronic databases and published systematic reviews using relevant keywords.
Case scenarios : We developed two clinical algorithms: one for abnormally slow labour progression and arrest during first and one for second stage. The algorithms provide definitions of suspected and confirmed slow progress of labour or arrest, initial assessment and ongoing monitoring, differential diagnosis, and management of the abnormalities, as well as links to other algorithms for labour management.
Conclusions: Identifying abnormal progress of labour is often challenging. These algorithms may help to reduce misdiagnosis and the unnecessary use of interventions to accelerate labour. We hope these algorithms will help health providers identify abnormal labour progress and institute prompt management or referral where needed.
Funding: This work was funded by the Bill & Melinda Gates Foundation (Grant #OPP1084318); The United States Agency for International Development (USAID); and the UNDP-UNFPA-UNICEF-WHO-World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored program executed by the World Health Organization (WHO). The funders had no role in design, data collection and analysis, decision to publish, or preparation of the manuscript.
Keywords: labour, active first stage, duration, delay, protracted, dystocia, second stage of labour, abnormal, length, prolonged labour.
Tweetable abstract: Evidence-based clinical algorithms may help or standardize early identification and management of abnormally slow labour progress or arrest.