Malpresentations, malpositions and cephalopelvic disproportion. The presenting part is not fitting in the lower uterine segment leading to absence of reflex uterine contractions. Full bladder and rectum. Uterine contractions are infrequent, weak and of short duration. Slow cervical dilatation.
Membranes are usually intact.
The foetus and mother are usually not affected apart from maternal anxiety due to prolonged labour. More susceptibility for retained placenta and postpartum haemorrhage due to persistent inertia. Prophylactic antibiotics in prolonged labour particularly if the membranes are ruptured. Uterine contractions are irregular and more painful. The pain is felt before and throughout the contractions with marked low backache often in occipito-posterior position.