OBSTRUCTED Labour islamic University YR 3.pptx

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1. OBSTRUCTED LABOUR BALA ALHAJI BALA MBchB YEAR 3 1

2. OBSTRUCTED LABOUR Definition : obstructed labour can be define as a labour where there is poor or no progress of labour in spite of good uterine contractions . Incidence : 1 -2% of all referral cases in developing countries. A major cause of obstetric referrals and emergencies Second Leading cause of maternal morbidity and mortality 2

3. OBSTRUCTED LABOUR Causes : Maternal condition (fault in the passage):- Contracted pelvis Abnormal pelvis :- android, anthropoid Pelvic tumor :- fibroid, ovarian tumor, tumor of rectum, bladder or pelvic bone. Abnormality in uterus & vagina :-stenosis in cervix . & vagina, contraction ring in uterus, vaginal septum, rigid perineum. 3

4. OBSTRUCTED LABOUR Causes : Foetal condition (fault in the passenger):- Macrosomic baby Malpresentation Malposition :- transverse lie Malformed foetus:- hydrocephalus, foetal Ascitis , conjoint twins, cord around the neck. Locked twins 4

5. OBSTRUCTED LABOUR Diagnosis Partograph will recognize impending obstruction early. If the labour is slow to progress, careful general, abdominal and vaginal examination is necessary . Woman gives a history of:- Prolonged labour The labour pain becomes severe , frequent and unrelenting. Bearing down with unsuccessful delivery. 5

6. OBSTRUCTED LABOUR Diagnosis On Examination :- General examination:- Features of maternal distress i.e. Exhaustion & ketoacidosis Dehydration Tachycardia > 100b/m Raised temperature/pyrexia Scanty urine 6

7. OBSTRUCTED LABOUR Diagnosis On Examination :- Abdominal examination :- The retraction ring ( B andl’s ring ) is seen and felt between the tonically contracted upper segment of the uterus and the distended , tender and stretched lower segment. Tetanic contractions in prime gravidas (PGs). Distended urinary bladder. Fetal Heart Sound shows evidence of foetal distress or even absent 7

8. OBSTRUCTED LABOUR Diagnosis On Examination :- Vaginal examination:- The vulva usually swollen and edematous . The vaginal is dry, hot and occasionally offensive and purulent discharge . The cervix is almost fully dilated or hanging like a curtain. The presenting part is extremely moulded and jammed in the pelvis- grade 3 moulding . There is usually large caput formation . 8

9. MANAGEMENT OF OBSTRUCTED LABOUR Curative :- Immediate management General management Obstetric management ACTUAL TREATMENT : The underlying principles are: To relieve the obstruction at the earliest by a safe delivery procedure To combat dehydration and keto acidosis To control sepsis. 9

10. MANAGEMENT OF OBSTRUCTED LABOUR Immediate management :- Correct maternal dehydration Contraction prevent by tocholytic drugs. Blood sample send for grouping and cross matching. Antibiotic cover: prophylactic or treatment 10

11. MANAGEMENT OF OBSTRUCTED LABOUR General management :- Assessment of vital of mother and general condition. IV fluid to correct dehydration. Broad spectrum antibiotics. Catheterization. Sodium bicarbonate infusion to correct acidosis. 11

12. MANAGEMENT OF OBSTRUCTED LABOUR Obstetric management :- Delivery of foetus:- Vaginal delivery:- Destructive opt . ( dead foetus) If the delay occurs in the second stage as a result of deep transverse arrest the obstetrician may try to deliver the baby vaginally with ventouse If head is low and vaginal delivery is not risky, forceps extraction may be done in alive foetus also. 12

13. MANAGEMENT OF OBSTRUCTED LABOUR Obstetric management :-Delivery of foetus:- Caesarean section:- A live foetus Over distended lower segment with impending rupture even if the foetus is dead . 13

14. MANAGEMENT OF OBSTRUCTED LABOUR Obstetric management :-third stage:- Active management of 3rd stage of labour. Continuous bladder drainage for 2-3 days to prevent VVF . Continue with resuscitation measures Continue with antibiotics x at least 72 hrs post delivery. 14

15. OBSTRUCTED LABOUR Complications: Maternal Rupture of uterus VVF RVF PPH Puerperal sepsis Shock Maternal death Fetal Intra uterine asphyxia Intracranial haemorrhage Neonatal infection Acidosis Foetal death 15

16. MANAGEMENT OF PROLONGED AND OBSTRUCTED LABOUR Preventive :- Proper assessment of pregnant woman during ANC . Regular Antenatal visit. Proper assessment in early labour to detect the cause or risk factors if any. Partograph has to be strictly followed . Adequate support during labour: physical and psychological Prompt follow appropriate treatment to solve the problems. 16

17. MANAGEMENT OF PROLONGED AND OBSTRUCTED LABOUR Preventive :- Midwifery care: Adequate food and fluid intake Provide rest measures Psychological support Relieve pain by back massage, changes of position, a warm bath or some simple analgesia. Artificial rupture of membranes (Arm) at this stage can interfere with the action of amniotic prostaglandin on the cervix ,so it should be avoided. Unless necessary 17

18. MANAGEMENT OF PROLONGED AND OBSTRUCTED LABOUR Preventive :- The partogram : a graphical representation of dilatation of the cervix against time with an alert line based on cervical dilatation of 1 cm/ hr between 4 cm and 10 cm. The partogram provides information where progress deviates from the normal range . When labour is confirmed, the cervical dilatation is plotted on this line. An action line parallel to the alert line is placed 4 hrs to the right to highlight slow progress and indicate the timing of intervention for failure to progress or prolonged labour. The WHO recommends the use of a 4 hrs action line to improve maternal or neonatal outcome . 18

19. REFERRENCES DC DUTTA’S TEXTBOOK OF OBSTETRICS OBSTETRICS BY TEN TEACHERS 19