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Overview of normal labor and protraction and arrest disorders

Robert M Ehsanipoor, MD
Andrew J Satin, MD, FACOG
Section Editor
Charles J Lockwood, MD, MHCM
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).


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 — There are three stages of labor:

First stage – Time from onset of labor to complete cervical dilation. However, the precise time of labor onset is nearly impossible to determine since the normal uterus contracts intermittently and irregularly throughout gestation and the first regular contractions of labor are mild and infrequent. Likewise, the time the cervix first begins to change as a result of contractions is impossible to determine precisely by intermittent physical examinations. For this reason, contemporary research studies often define the first stage of labor as the time from hospital admission to complete dilation or the time from 4 cm dilation to complete dilation.

The first stage consists of a latent phase and an active phase. The latent phase is characterized by gradual cervical change and the active phase is characterized by rapid cervical change. The labor curve of multiparas may show an inflection point between the latent and active phases; this point occurs at about 5 cm dilation [1]. In nulliparas, the inflection point is often unclear and, if present, occurs at a more advanced cervical dilation. In any case, this inflection point is a retrospective diagnosis.


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Literature review current through: Apr 2016. | This topic last updated: May 16, 2016.
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