A study of the management of prolonged labor

Abstract The following results were obtained in a study of 556 cases of prolonged labors, part of which were treated inactively (watchful expectancy) and the remainder treated actively (artificial rupture of the fetal membranes and/or administration of posterior pituitary extract where indicated): 1. 1. Artificial rupture of fetal membranes alone produced adequate uterine contractions resulting in the delivery of 32.7 per cent of all patients in the active series. 2. 2. Posterior pituitary extract was effective in producing satisfactory progress in 95.8 per cent of cases (161 cases) of uterine inertia which failed to respond to rupture of the membranes. Operative delivery was deemed necessary in 4.2 per cent. The effective dose varied from 1 minim (45.8 per cent) to over 4 minims (4.27 per cent). 3. 3. There were no deleterious effects upon either the fetus or mother that could be attributed to the artificial rupture of the fetal membranes or to the administration of posterior pituitary extract. Active treatment produced no obvious deleterious effect on mother or baby. 4. 4. The incidence of protracted labors was reduced in the active series; 6.4 per cent of the primiparas in the active group were in labor over 36 hours as compared to 36.4 per cent of the inactive group, and 0.9 per cent of the multiparas in the active group were in labor for over 36 hours as compared to 17.3 per cent in the inactive group. 5. 5. There was a distinct decrease in incidence of midforceps deliveries in the active series. The rate of cesarean section was higher in the active group (3.0 per cent to 1.0 per cent). 6. 6. The rate of other operative procedures (Duhrssen's incisions and craniotomies) was higher in the inactive series. 7. 7. The incidence of maternal complications was greater in the inactive series than in the active series. 8. 8. The maternal morbidity was 1.1 per cent in the active series as compared to 4.3 per cent (corrected) in the inactive series. 9. 9. The fetal mortality was 0.75 per cent in the active series as compared to 4.5 per cent in the inactive series. 10. 10. There were no maternal deaths in either series.