Management of Active Phase Protraction Disorder
Defining the Labor Abnormality
- Active phase protraction disorder is defined as slower-than-normal cervical dilation during active phase, with progression from 4 cm to 5 cm over 4 hours being 0.25 cm/hour, according to the American College of Obstetricians and Gynecologists 4, 3
- Arrest requires no cervical change for ≥4 hours with adequate contractions (≥200 Montevideo units) after reaching ≥6 cm dilation, as stated by the American College of Obstetricians and Gynecologists 3
Why Oxytocin is the Correct Answer
- Oxytocin augmentation is first-line treatment for active phase protraction when cephalopelvic disproportion (CPD) is not evident, with a 92% success rate for vaginal delivery, recommended by the American College of Obstetricians and Gynecologists 2
- The American College of Obstetricians and Gynecologists recommends oxytocin augmentation for active phase protraction disorder, with a high success rate for vaginal delivery 2
Critical Assessment Before Oxytocin
- Before initiating oxytocin, assess for factors suggesting CPD, including fetal macrosomia, fetal malposition, excessive molding or asynclitism, and maternal factors such as diabetes, obesity, and small pelvic dimensions, as recommended by the American College of Obstetricians and Gynecologists 4, 2, 3
- If CPD is suspected or cannot be ruled out with reasonable certainty, cesarean delivery is safer than attempting vaginal delivery, according to the American College of Obstetricians and Gynecologists 4
Monitoring During Oxytocin Augmentation
- Discontinue oxytocin immediately if signs of fetal distress or uterine hyperactivity occur, as recommended by the American College of Obstetricians and Gynecologists 2
- If no progress occurs after 4 hours of adequate oxytocin augmentation (≥200 Montevideo units), reassess for CPD and consider cesarean delivery, according to the American College of Obstetricians and Gynecologists 1, 2