Prolonged Labour in Multigravidae

Summary An analysis is presented of labours lasting 36 hours or longer in 155 multigravidae delivered at the Royal Women's Hospital, Melbourne, from 1958 to 1965. The method of delivery was Caesarean section in 24%, forceps delivery in 21%, and unaided vaginal delivery in 49%. In booked patients the corrected perinatal mortality was 40/1000 and in non‐booked patients it was 100/1000; the overall perinatal mortality was 111/1000. The perinatal mortality was highest in those delivered by Caesarean section and in those who had a difficult vaginal delivery; it was not raised in those who had an unaided vaginal delivery. Cephalopelvic disproportion was common; 48% of the babies delivered weighed over 4000g. Friedman's curves showing dilatation of the cervix against elapsed time were found to be invaluable in predicting the outcome of prolonged labours. Prolongation of the latent phase of labour carried a low perinatal mortality (33/1000, corrected to 0/1000) and a 70% normal vaginal delivery rate; a protracted active phase or secondary arrest in the active phase of labour carried perinatal mortality rates of 180/1000 (corrected 109/1000) and 200/1000, and a very high Caesarean section rate. Analysis of the prolonged labours showed that favourable prognostic signs for the vaginal delivery of a healthy baby were (in order of importance) a favourable fetal lie and position, good placental function, membranes remaining intact until late in labour, and lack of maternal distress. Signs of maternal distress (such as the need for intravenous fluids, frequent analgesics, or a rising maternal pulse) or the need for oxytocin infusion because of delay in the active phase pointed to the need for careful evaluation and possible early Caesarean section.