Labor: Overview of Normal and Abnormal Progression

Ehsanipoor RM, Satn AJ. Labor: overview of normal and abnormal progression. Uptodate, 2022

Labor is defined as regular and painful uterine contractions that cause progressive dilation and effacement of the cervix. The rate of cervical dilation becomes faster after the cervix is completely effaced [1]. Normal labor results in descent and eventual expulsion of the fetus. Parity affects this process: Parous patients who have had a previous vaginal birth have faster labors than nulliparous patients.

Although determining whether labor is progressing normally is a key component of intrapartum care, determining the time of labor onset, measuring its progress, and evaluating the uterine, fetal, and pelvic factors that affect its course are an inexact science. “Abnormal labor,” “dystocia,” and “failure to progress” are traditional but imprecise terms that have been used to describe a labor pattern deviating from that observed in most patients who have a spontaneous vaginal birth. These labor abnormalities are best described as protraction disorders (ie, slower than normal progress) or arrest disorders (ie, complete cessation of progress). By convention, an abnormally long active phase is usually described as protracted, whereas an abnormally long latent phase or second stage is usually described as prolonged.

Recognizing abnormal labor progression and initiating appropriate interventions are important because it is associated with increased risks for operative delivery and maternal and neonatal morbidity.

This topic will provide an overview of labor progress and discuss risk factors for abnormal progression. Management of normal labor and delivery; diagnosis and management of abnormalities of the latent phase, first stage, and second stage; and management of the third stage are reviewed separately:

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