(Unsatisfactory Progress of Labor)

Definition

Failure to progress (FTP) happens when labor slows and delays delivery of the baby. Before labor starts, the cervix thins out and starts to open. With FTP, this may not happen.

Once labor starts, the baby should move down the birth canal at a certain pace.

Fetal Descent Stations (Birth Presentation)
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The progress of the baby can be progressively measured.
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Causes

The cause of FTP may be linked to:

  • The unborn baby cannot fit through the mother's pelvis
  • The baby is not in the right position
  • Contractions that are weak or do not happen often enough

Sometimes, the cause is not known.

Risk Factors

Factors that may increase the risk of FTP include:

  • Starting labor with medicine or other methods
  • Epidural—pain medicine placed into the spine
  • Problems with the fluid sac around the unborn baby
  • Water breaks before labor starts—premature rupture of membranes
  • A large baby
  • Prior FTP
  • Diabetes
  • Fertility treatments

Symptoms

Labor has more than one phase. The active phase means the cervix:

  • Shortens and thins out
  • Opens to 4 or more centimeters (cm)—fully opened is 10 cm

Once active labor has started, the baby should move down the birth canal at a certain pace. The baby's progress is either slower than this pace or it or stops.

Diagnosis

The doctor will check:

  • Width of the cervix
  • Size of the baby
  • Position of the baby
  • How strong the contractions
  • How the contractions last

FTP can be diagnosed based on this if the mother is in the active phase of labor.

The doctor may use a monitor to find out how the uterus is contracting. A device is placed into the uterus. It can count how many contractions there are, how long they last, how powerful they are, and how much time goes by between each one.

Treatment

Treatment is aimed at starting labor or speeding it up. This can be done with:

  • Rupture of membranes—A special tool is used to break the water.
  • Oxytocin—A medicine used to make the uterus contract.

FTP can cause stress on the mother and baby, leading to problems. Delivery options include:

  • Vacuum or forceps—to help the baby out of the birth canal during the final stages of delivery
  • Surgical delivery such as with a cesarean section

Medicine can be used to ease pain at any time. It is usually done with a spinal injection called an epidural. This will numb the belly and legs.

Prevention

There is no way to prevent FTP because the cause is not known.

RESOURCES

Office on Women's Health  https://www.womenshealth.gov 

The American College of Obstetricians and Gynecologists  https://www.acog.org 

CANADIAN RESOURCES

The Society of Obstetricians and Gynaecologists of Canada  https://www.sogc.org 

Women's Health Matters—Women's College Hospital  http://www.womenshealthmatters.ca 

References

Assisted vaginal delivery (instrumental delivery). EBSCO DynaMed Plus website. Available at:  https://www.dynamed.com/topics/dmp~AN~T115335/Labor-induction . Updated January 31, 2019. Accessed March 7, 2019.

Labor dystocia. EBSCO DynaMed website. Available at:  https://www.dynamed.com/topics/dmp~AN~T115364/Labor-dystocia . Updated March 6, 2015. Accessed March 7, 2019.

Labor induction. The American College of Obstetrics and Gynecology website. Available at: https://www.acog.org/Patients/FAQs/Labor-Induction. Updated September 2017. Accessed March 7, 2019.

Protracted labor. Merck Manual Professional Version website. Available at: https://www.acog.org/Patients/FAQs/Labor-Inductionhttps://www.merckmanuals.com/professional/gynecology-and-obstetrics/abnormalities-and-complications-of-labor-and-delivery/protracted-labor. Updated June 2018. Accessed March 7, 2019.

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