Clinical algorithms for identification and management of delay in the progression of first and second stage of labour

Aim To develop clinical algorithms for the assessment and management of slow progress of labour. Population Low‐risk singleton, term, pregnant women in labour. Setting Institutional births in low‐ and middle‐income countries. Search strategy We systematically reviewed the literature on normal labour progression, and guidance on clinical management of abnormally slow progression from 1 December 2015 to 1 October 2020 from relevant international guidelines, Cochrane reviews and primary research studies in PubMed by searching for international and national guidance documents, electronic databases and published systematic reviews using relevant keywords. Case scenarios We developed two clinical algorithms: one for abnormally slow labour progression and arrest during first stage and one for the second stage. The algorithms provide definitions of suspected and confirmed slow progress of labour or arrest, initial assessment and ongoing monitoring, differential diagnosis, and management of the abnormalities, as well as links to other algorithms for labour management. Conclusions Identifying abnormal progress of labour is often challenging. These algorithms may help healthcare providers identify abnormal labour progress and institute prompt management or referral where needed but also reduce misdiagnosis and unnecessary use of interventions to accelerate labour. Tweetable abstract Evidence‐based clinical algorithms may help and standardize early identification and management of abnormally slow labour progress or arrest. Tweetable abstract