Obstructed labour

This topic contains definition, incidence, causes, effect on mother and fetus, clinical features, prevention, management of Obstructed labour.

1. BY, MS.PRIYANKA GOHIL
M.Sc. (N) OBG,
phD Scholar in Nursing

2. “ Obstructed labour is one where
inspite of good uterine contractions, the
progressive descent of the presenting
part is arrested due to mechanical
obstruction.”
This may result either due to factors in
the fetus or in the birth canal or both, so
that further progress is almost
impossible without assistance.

3. In the developing countries, the
prevalence is about 1-2 % in the referral
hospitals.

5. 1. BONY
Cephalo pelvic disproportion and
contracted pelvis are the common
causes.
Secondary contracted pelvis may be
encountered in multiparous women.

6. 2. SOFT TISSUE OBSTRUCTION
This includes cervical dystocia due to
prolapse or previous operative scarring,
cervical or broad ligament fibroid,
impacted ovarian tumor or the non-
gravid horn of a bicornuate uterus below
the presenting part.

7. Transverse lie
Brow presentation
Congenital malformations of the fetus-
hydrocephalus ( commonest), fetal
ascites, double monsters
Big baby, occipito-posterior position
Compound presentation
Locked twins

8. IMMEDIATE:
Exhaustion
Dehydration
Metabolic acidosis
Genital sepsis
Injury to the genital tract includes rupture
of the uterus
Postpartum hemorrhage and shock
The death are due to rupture of uterus,
shock and sepsis with metabolic changes.

9. REMOTE:
Even if the patient survives, the
following legacies may be left behind:
1.Genito-urinary fistula or rectovaginal
fistula
2.Variable degree of vaginal atresia
3.Secondary amenorrhoea following
hysterectomy due to rupture or due to
Sheehan's syndrome (pitutary gland
damage during childbirth)

10. Asphyxia
Acidosis
Intracranial heamorrhage
Infection
All these lead to increased perinatal
loss.

11. Patient is in agony
Features of exaustion
On abdominal examination:- upper
segment is hard and tender, lower
segment is distended and tender.

12. Antenatal detection of the factors likely
to produce prolonged labor. ( big baby,
small women, malpresentation and
position)
Intranatal: Continuous vigilence, use of
partograph and timely intervention of a
prolonged labour due to mechanical
factors can prevent obstructed labour.

13. Failure in progress of labour inspite of
good uterine contractions for a
reasonable period ( 2-4 hours) is an
impending sign of obstructed labour.

14. The underlying principles are:
1.To relieve the obstruction at the earliest
by a safe delivery procedure.
2.To combat dehydration and ketoacidosis
3.To control sepsis

15. PRELIMINARIES
1.Fuild electrolyte balance and correction
of dehydration and ketoacidosis.
2.A vaginal swab tissue culture and
sensitivity test
3.Blood examination
4.Antibiotic: 1 g cefriaxone IV
5.Metronidazole for IV for anaerobic
infection

16. Before proceeding for definitive operative
treatment, rupture of the uterus must be
excluded.
A balanced decision should be taken
about the best method of relieving the
obstruction with least hazards to the
mother.
Frantic attempt to deliver a moribund
(dying) baby by a method ignoring the
risk involved to the risk involved to the
mother is indeed bad obstetricss.

17. There is no place of “wait and watch”,
neither is any scope of using oxytocin
to stimulate uterin contraction.

19. After complition of the delivery and
expulsion of the placenta, exploration
of the uterus and the lower genital tract
should be done to exclude uterine
rupture or tear.

21. Not infrequently, the baby is either
delivered stillborn or dies neonatal
sepsis.
The postoperative period of the mother
also becomes stormy and at times,
ends fatally.