Protracted Active Phase

The active phase of labor is defined as dilation of the cervix occurring at a rate of at least 1.2 cm/hr for nulliparous women and 1.5 cm/hr for multiparous women. A slower rate of dilation is known as protracted active phase or primary dysfunctional labor. The etiologies of a protracted active phase include fetal malposition (e.g., occiput posterior), relative cephalopelvic disproportion (CPD), inadequate uterine contractions, and anesthesia. Historically, debate has surrounded its management. The current trend is active management with oxytocin to optimize uterine contractions. A protracted active phase is a frequent predecessor of secondary arrest of cervical dilation and is associated with an increased risk of operative delivery.

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