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# Labour dystocia (arrest of labour, cephalopelvic disproportion)

Labour dystocia is labour that progresses too slowly or stops, because of weak contractions, a large or badly positioned baby, or a narrow [pelvis](https://durgical.com/en/anatomy/region/pelvis/).

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Cervix](https://durgical.com/en/anatomy/cervix-of-uterus/)
- [Myometrium](https://durgical.com/en/anatomy/myometrium/)
- [Lower uterine segment](https://durgical.com/en/anatomy/isthmus-of-uterus/)
- [Sacrum](https://durgical.com/en/anatomy/sacrum/)
- [Coccyx](https://durgical.com/en/anatomy/coccyx/)
- [Pubic symphysis](https://durgical.com/en/anatomy/pubic-symphysis/)

## Why it happens

- [Parturition: onset and uterine contraction](https://durgical.com/en/physiology/parturition-onset-and-uterine-contraction/)

## What it is

Abnormally slow (protracted) or stopped (arrested) progress of labour, measured as cervical dilation in the first stage or descent of the fetal head in the second stage. It is the most common reason for a first caesarean delivery.

## Who gets it

A frequent problem in labour wards everywhere and the leading indication for primary caesarean section. Where labour is not monitored and caesarean access is late, as in some rural areas of Latin America, untreated obstruction still causes uterine rupture, obstetric fistula and maternal and perinatal death.

## Causes

- "Power": contractions that are too weak or infrequent (hypotonic), or uncoordinated or too frequent (hypertonic)
- "Passenger": large baby (macrosomia), malposition such as occiput posterior or transverse, deflexed or brow presentation, fetal anomalies
- "Passage": small or abnormally shaped bony pelvis (cephalopelvic disproportion), soft-tissue obstruction such as fibroids
- Contributors: dense epidural block, maternal exhaustion, chorioamnionitis

## Risk factors

- First labour (nulliparity) and advanced maternal age
- Maternal obesity and short stature
- Fetal macrosomia, gestational or pre-existing diabetes
- Post-term pregnancy and induction of labour
- Occiput posterior position
- Previous pelvic fracture or rickets-related pelvic deformity

## Pathophysiology

Normal labour needs effective uterine contractions to dilate the cervix and push the fetal head through the pelvic inlet, mid-pelvis and outlet with flexion and rotation. When the forces are weak, the head is too large or poorly positioned, or the bony canal is narrow, progress slows or stops. Prolonged obstruction thins the [lower uterine segment](https://durgical.com/en/anatomy/isthmus-of-uterus/), compresses maternal tissues against the pelvis and reduces placental blood flow during contractions.

## Classification

- Protraction disorder: progress continues but more slowly than expected
- First-stage arrest: no cervical change despite adequate contractions or oxytocin once in active labour (about 6 cm or more)
- Second-stage arrest: no descent or rotation of the head after an adequate period of pushing (longer allowance for nulliparas and with epidural)
- Obstructed labour: mechanical blockage despite good contractions

## Symptoms and signs

- Cervical dilation that stalls on serial examinations, plotted on a partogram
- Fetal head that remains high or does not descend despite pushing
- Caput (scalp swelling) and moulding of the fetal skull bones
- Maternal exhaustion, dehydration and fever in prolonged labour
- Oedema of the cervix or anterior lip

## Red flags

- Bandl ring (pathological retraction ring) or constant pain between contractions: impending uterine rupture
- Abnormal fetal heart rate pattern
- Maternal fever or foul-smelling amniotic fluid (chorioamnionitis)
- Haematuria or bladder distension in obstructed labour
- Severe moulding with a high head: do not attempt instrumental delivery

## Diagnosis

**Clinical**
Diagnosed clinically by serial vaginal examinations of dilation, effacement, station and position, compared with expected progress on a partogram, together with assessment of contraction strength and frequency and of pelvic size.

**Tests**
Tocodynamometry or an intrauterine pressure catheter to judge whether contractions are adequate; continuous fetal heart monitoring; blood count and cultures if infection is suspected.

**Imaging**
Intrapartum ultrasound can confirm fetal head position and station. Pelvimetry by imaging is not used to predict disproportion.

## Differential diagnosis

- False labour or latent phase (not yet active labour)
- Malpresentation such as breech, brow or face
- Shoulder dystocia (obstruction after the head is born)
- Hypertonic contractions from excess oxytocin
- Unrecognised uterine rupture with loss of station

## Goal of treatment

Correct the cause when possible (improve contractions, rotate or reposition), avoid unnecessary caesareans in the latent phase, and deliver safely by assisted vaginal birth or caesarean when true arrest occurs, while watching mother and baby.

## Treatment

**Conservative**
Support, hydration, emptying the bladder, position changes and continuous companionship; allow more time when progress is slow but continuing and mother and baby are well.

**Medical**
Augmentation with oxytocin when contractions are inadequate, often after amniotomy; reduce or stop it if contractions become too frequent or the fetal heart rate worsens.

**Procedure**
Operative vaginal delivery with vacuum or forceps for second-stage arrest when the head is low enough and the [cervix](https://durgical.com/en/anatomy/cervix-of-uterus/) fully dilated.

**Surgical**
Caesarean delivery for confirmed arrest in active labour, obstructed labour, cephalopelvic disproportion or failed instrumental delivery.

**Follow-up**
Nursing: partogram, contraction pattern, fetal heart rate, maternal vital signs, temperature, bladder and fluid balance; prepare for possible haemorrhage after delivery.

## Drugs for this condition

- [Oxytocin](https://durgical.com/en/pharmacology/oxytocin/)

## Complications

- Chorioamnionitis and postpartum endometritis
- Postpartum haemorrhage from uterine atony
- Uterine rupture in neglected obstruction
- Obstetric (vesicovaginal or rectovaginal) fistula
- Severe perineal tears and shoulder dystocia
- Fetal hypoxia, birth injury and neonatal infection

## Prognosis

With partogram monitoring and timely augmentation or caesarean, the outcome for mother and baby is usually good. Neglected obstructed labour carries high maternal and perinatal mortality.

## Prevention

- Avoid admitting women in the latent phase and avoid unnecessary inductions
- Use a partogram and continuous labour support
- Good glycaemic control in diabetes to limit macrosomia
- Timely referral from settings without caesarean capacity

## Test yourself

Think of the answer, then tap the question to see it.

## What are the three classic groups of causes of labour dystocia?

Power (contractions), passenger (fetal size, position, presentation) and passage (bony pelvis and soft tissues).

## What is the first step when active-phase labour stalls with weak contractions?

Augmentation with oxytocin, often after amniotomy, while monitoring the fetal heart rate.

## What tool is used to plot labour progress and detect dystocia early?

The partogram (a graph of cervical dilation and head descent over time).

## What sign in obstructed labour warns of impending uterine rupture?

A pathological retraction ring (Bandl ring) with a thinned, tender lower uterine segment.

## What is the most common indication for a first caesarean delivery?

Labour dystocia (failure to progress or arrest of labour).

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## Related conditions

- [Shoulder dystocia](https://durgical.com/en/conditions/shoulder-dystocia/)
- [Uterine rupture](https://durgical.com/en/conditions/uterine-rupture/)
- [Chorioamnionitis (intra-amniotic infection)](https://durgical.com/en/conditions/chorioamnionitis/)
- [Postpartum haemorrhage](https://durgical.com/en/conditions/postpartum-haemorrhage/)
- [Obstetric fistula (vesicovaginal and rectovaginal)](https://durgical.com/en/conditions/obstetric-fistula/)
- [Intrapartum fetal compromise (non-reassuring fetal status)](https://durgical.com/en/conditions/intrapartum-fetal-compromise/)
- [Breech and other malpresentations](https://durgical.com/en/conditions/breech-and-other-malpresentations/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Protracted or Arrested Labor](https://www.msdmanuals.com/professional/gynecology-and-obstetrics/labor-and-delivery/protracted-or-arrested-labor) (MSD Manual Professional Edition, 2024).

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Source: https://durgical.com/en/conditions/labour-dystocia/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/labour-dystocia/