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1/1/2019

Management of Prolonged Latent Phase

Author: Callie Bauer, DO, FACOG

Mentor: Marygrace Elson, MD, MME, FACOG
Editor: William Po, MD

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The first stage of labor is defined as the interval between the onset of labor and complete or 10 cm cervical dilation. The first stage is further divided into two phases: latent and active. The latent phase of labor is characterized by gradual and relatively slower cervical dilation that starts on perception of regular uterine contractions and ends when rapid cervical change initiates. This phase of rapid cervical change is termed the active phase of labor and continues until complete cervical dilation.

The 2010 data published by Zhang et al from the Consortium on Safe Labor refined the definition of normal labor progress.  In the study, the latent phase of labor had a wide range of duration that was dependent on cervical examination at admission and parity, suggesting that a normal latent phase may have wide variation. Additionally, the 95th percentile rate of active-phase dilation was substantially slower than the standard rate derived from Friedman. From 4 cm to 6 cm, nulliparous and multiparous patients dilated at a similar rate. Beyond 6 cm, multiparous individuals dilated more rapidly than nulliparous individuals. The transition to the active phase of labor was achieved at 6 cm compared with the Friedman definition of 4 cm. The Consortium data did not show a deceleration phase at the end of the first stage of labor.

Regardless of parity. Labor may take more than 6 hours to progress from 4 cm to 5 cm of dilation and more than 3 hours to progress from 5 cm to 6 cm of dilation. The median latent-phase duration in nulliparous patients ranges anywhere from 0.6 to 6.0 hours based on the initial cervical examination. The most conservative estimate for the 95th percentile for duration between admission and active phase in nulliparous patients is 16 hours. A prolonged latent phase may be defined as longer than 16 hours.

Most pregnant individuals with prolonged latent phase ultimately will enter the active phase, the remainder either will cease contracting or, with amniotomy or oxytocin (or both), achieve the active phase. There is no evidence-based definition for latent phase arrest. So, cesarean delivery performed for a prolonged latent phase in the setting of reassuring maternal and fetal status should be avoided. Among patients undergoing induction of labor, “failed induction of labor” should be the terminology when there is no progression in latent phase.

Multiple nonpharmacologic supportive care measures have been suggested to assist labor progression during labor dystocia. These include, but are not limited to, peanut ball, hydration, perineal massage, water immersion, acupuncture, ambulation, and positioning strategies.  Published data indicate that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel or the continuous presence of a one-on-one person for support.

ACOG recommends; That neuraxial anesthesia be offered for pain relief during any stage of labor, that early amniotomy as adjunctive to the labor process to decrease time to delivery without increasing the cesarean delivery rate or other maternal or neonatal complications, and either low-dose or high-dose oxytocin strategies as reasonable approaches to the active management of labor to reduce operative deliveries

Therapeutic rest via analgesics or sedatives, such as morphine (IM or IV), oral narcotics, or zolpidem, is appropriate when there is no indication for delivery, to relieve the patient’s discomfort, and to allow rest while monitoring for labor progression. The provider should engage in shared decision making with the patient about continued monitoring in the hospital or possible discharge to home with a plan for communication and subsequent evaluation.

 

Further Reading:

Initial Approval: November 2018, Published January 2019; Revised July 2020; Reaffirmed January 2022. Reaffirmed November 2023. Revised July 2025.

 

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