Interpretation
Identifying abnormal progress of labour that justifies a medical intervention is often challenging. Thus, ‘failure of labour to progress’ -a term poorly defined but generally accepted -has become a leading indication for oxytocin augmentation and primary caesarean section.3 The implementation of the 5-cm cervical dilatation as benchmark of the active phase of the first stage of labour might be cost-effective because it reduces the use of interventions such as caesarean section, oxytocin augmentation, cardiotocography, pain relief and antibiotics.2 It is expected that the algorithms on labour arrest and delay in second stage of labour presented here, will help healthcare providers to follow a more conscious management of these conditions, respecting labour progress and avoiding unnecessary interventions.
These algorithms should be adapted to local context, taking into considerations availability of skilled personnel and other resources.
Developing the algorithm highlighted the need for more data on the epidemiology of delay in the progression of first and second stage of labour and its management in the light of the new definitions of active first stage and second stage in recently published WHO recommendations.2