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Normal and abnormal labor progression

Robert M Ehsanipoor, MD
Andrew J Satin, MD, FACOG
Section Editor
Vincenzo Berghella, MD
Deputy Editor
Vanessa A Barss, MD, FACOG


During normal labor, regular and painful uterine contractions cause progressive dilation and effacement of the cervix, accompanied by descent and eventual expulsion of the fetus. "Abnormal labor," "dystocia," and "failure to progress" are traditional but imprecise terms that have been used to describe a labor pattern deviating from that observed in the majority of women who have a spontaneous vaginal delivery. These labor abnormalities are best described as protraction disorders (ie, slower than normal progress) or arrest disorders (ie, complete cessation of progress). — By convention, an abnormally long active phase is usually described as protracted, whereas an abnormally long latent phase or second stage is usually described as prolonged.

This topic will describe normal labor progress and discuss the diagnosis and management of protraction and arrest disorders. Management of normal labor and delivery is reviewed separately. (See "Management of normal labor and delivery".)


Although determining whether labor is progressing normally is a key component of intrapartum care, determining the onset of labor, measuring its progress, and evaluating the factors (power, passenger, pelvis) that affect its course are an inexact science.

Stages and phases — Interpretation of labor progress depends on the stage and phase. The three stages and their phases are:

First stage – Time from onset of labor to complete cervical dilation. Clinically, women are simply asked the time when they believe labor began (ie, when contractions started to occur regularly every 3 to 5 minutes for more than an hour) to document the onset of labor. The time that complete dilation is first identified on physical examination documents the end of the first stage. The precise times of both the start of labor and of complete dilatation are impossible to determine since the normal uterus contracts intermittently and irregularly throughout gestation, the initial regular contractions at the onset of labor are mild and infrequent, initial cervical changes are subtle, and physical examination to document cervical change is performed intermittently.

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Literature review current through: Dec 2017. | This topic last updated: Oct 13, 2017.
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