Prolonged Latent Phase

The latent phase of the first stage of labor is variable in length, but usually less than 20 hours for a nullipara and 14 hours for a multipara. It is defined by the onset of regular contractions and is terminated by the onset of the active phase. The rate of dilation is usually 0.6 cm/hr or less. This phase is considered prolonged if it falls outside these parameters. The possible etiologies include an unripe cervix, false labor, sedation, and uterine inertia. The management of this condition is primarily conservative unless there is an expeditious need to deliver the fetus. This includes rest, observation, and possibly oxytocin augmentation. Maternal rest can be induced by a therapeutic dose of morphine, to provide a respite from the stresses of early labor and to promote sleep. The vast majority of these patients will declare themselves and either progress into labor or cease contractions, and then the diagnosis of false labor can be made. Amniotomy should be avoided in this phase because it increases the risk for cho-rioamnionitis. A prolonged latent phase in itself is not an indication for cesarean section.

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