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