Women who do not make progress in cervical dilatation at less than 4 cm can be managed expectantly, with analgesia and rest as needed. They generally have good outcomes and can often deliver vaginally with no further complications, similar to women who did not have a prolongation of the latent phase of labour. According to the SOGC Clinical Practice Guideline on Management of Labour, “Dystocia cannot be diagnosed prior to the onset of labour or during the latent phase of labour; caesarean section carried out at this time for an indication of dystocia is inappropriate.” The end of the latent phase is subject to reassessment, the transition to an active phase is easier to diagnose retrospectively. A description of labour curves suggest that the end of the latent phase may be at 6 cm, rather than 4 cm and that overall progress is slower than that originally described. Each obstetrical unit must decide the definition of entry into the active phase of the first stage of labour. Regardless, intervention for a diagnosis of presumed dystocia is inappropriate in whatever may be considered the latent phase. Women should be allowed the opportunity to advance in labour, which many will do if given time, and achieve a vaginal delivery and avoid a caesarean delivery. For more information:
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Friedman EA. Labour: clinical evaluation and management. Second edition. New York: Appleton Century Croft; 1978
Lee L, Dy J, Azzam H. Management of Spontaneous Labour at Term in Healthy Women. J Obstet Gynaecol Can 2016; 38:843 – 865. PMID: 27670710.
Zhang J, Troendle JF, Yancey, MK. Reassessing the labour curve in nulliparous women. Am J Obstet 2002; 187:824 – 28. PMID: 12388957.