How will diagnose abnormal progress of labour . Discuss its management in a PHC set up.

Abnormal progress of labor is a significant concern during childbirth, and it is crucial to identify it early to prevent complications for both the mother and the baby. Monitoring the progression of labor in a timely and systematic manner allows for the early detection of abnormal labor patterns and provides the opportunity for effective intervention, especially in a Primary Health Center (PHC) setup, where resources may be limited but essential care is available.

### Diagnosis of Abnormal Progress of Labor

The progression of labor is typically categorized into three stages: the first stage, the second stage, and the third stage. Labor is considered abnormal when there are deviations from the normal patterns expected in each stage, and it is diagnosed based on clinical signs, symptoms, and careful monitoring of the mother and fetus.

#### 1. First Stage of Labor (Latent and Active Phase)
   - Latent Phase: The early part of labor involves cervical dilation from 0 to 3 cm. Contractions are typically irregular and may be mild. Prolonged latent phase, lasting longer than 20 hours in primigravida or 14 hours in multigravida women, can be a sign of abnormal progress.
   - Active Phase: The cervix dilates from 3 cm to 10 cm, and contractions become more frequent and regular. The normal progress of the active phase should be about 1 cm of cervical dilation per hour. When dilation occurs at a slower rate (less than 1 cm per hour), it is considered an abnormal progression.
     - Diagnosis of Prolonged Active Phase: This is diagnosed when the active phase extends beyond 12 hours in a nulliparous woman or 8 hours in a multiparous woman without significant progress.
     - Diagnosis of Arrest of Active Phase: If the cervix fails to dilate for more than two hours in the presence of regular uterine contractions, it is classified as arrest of active phase. It can be further classified into “arrest of dilation” if no progress is seen, and “arrest of descent” if the presenting part does not descend despite good contractions.

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