10.4.1 Referral criteria for prolonged labour
Do not allow a woman to remain for a long time in the first or second stages of labour without making an efficient referral.
When should you refer a multiparous or primiparous woman whose labour is prolonged? (Think back to Study Session 9.)
Referral for prolonged labour should happen for all women if:
- The latent first stage of labour lasts more than 8 hours before entering into the active first stage
- The active first stage lasts more than 12 hours before entering into the second stage
- The second stage of labour lasts more than one hour in a multiparous woman, or more than two hours in a primiparous woman, unless the birth of the baby seems to be imminent.
Your major role is primary prevention – in this case, making sure that if there is obstructed labour, you can get the woman to a health facility for emergency care in time to prevent uterine rupture. However, there are many reasons why you may have to give emergency care yourself to a woman with a ruptured uterus, where your role will be secondary prevention of the complications associated with uterine rupture.
10.4 Interventions in ruptured uterus