The relationship of prolonged labor to fetal mortality

Abstract

c REAT strides have been made in recent years in the handling of major obstetrical problems. Chemotherapy and antibiotics have virtually eliminated puerperal sepsis. Readily available blood has reduced greatly the morbidity and mortality from hemorrhage, and careful prenatal observation and early treatment have lowered both the incidence and the mortality rate from eclampsia. The development. of accurate methods of x-ray pelvimetry has made it possible to improve the treatment of dystocia due to pelvic contracture. Our ignorance of uterine physiology, however, has prevented similar improvement in the handling of dystocia associated with ineffectual labor. This ignorance is well illustrated by the variety of terms by whieh this complication is known. Regardless of whether we speak of uterine inertia, uterine atony, cervical dystocia, or prolonged labor, the underlying difficulties are now recognized t,o be due to dysrhythmic uterine contractions alone or combined with dilatory cervical progression. Treatment has varied from watchful expectancy to operative interference and stimulation, often culminating in a combination of all three. Several reports from large teaching clinics have appeared in the last few years dealing chiefly with the treatment of uterine inertia with intravenous Pitocin or Pituitrin. The general policy of the Boston Ilying-in Hospital concerning the use of pituit,ary extracts has recently been outlined.’ However, with the exception of the work of Douglas and Stander,2 there has been minimal recent investigation of the causes of fetal death associated with prolonged labor. It seemed worth while, therefore, to review the records of the Boston Lyingin Hospital in this respect, and at t.he same time to attempt a correlation of antopsy findings with various rlinical ccvents. Such an investigation involved analysis of all premat~urc and term infant autopsies, and these will be considered briefly. A discussion of Ihe felal mortality in caws of ~n~~longed labor will t,hen be undertaken. Material