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.