Obstructed Labour ppt

Obstructed Labour

1. OBSTRUCTED LABOUR MOMINA KHAN FINAL YEAR MBBS ROLL NO: 08-103 BATCH: G

2. DEFINITION WHEN PROGRESS OF LABOUR IS COMPLETELY STOPPED DESPITE STRONG UTERINE CONTRACTIONS .

3. CAUSES: DISPROPORTION BETWEEN DIAMETER OF BIRTH CANAL AND FETUS. CAUSES IN MOTHER: CONTRACTED PELVIS (DEVELOPMENTAL, METABOLIC OR TRAUMATIC) PELVIC MASS a. FIBROIDS IN LOWER UTERINE SEGMENT b. OVARIAN CYSTS IMPACTED IN POUCH OF DOUGHLAS c. PELVIC KIDNEYS d. BONY TUMOURS OF PELVIS e. SOFT TISSUE TUMOURS ( BLADDER, RECTUM)

4. 3. CONGENITAL ABNORMALITIES OF UTERUS a. OBSTRUCTION OF UTERUS LIKE EXTRA TISSUE AT HYMEN OR ENTERENCE OF VAGINA . b. DOUBLE UTERUS . 4 .OBSTRUCTION DUE TO LOWER GENITAL TRACT CONDITIONS: a. CERVICAL STENOSIS b. VAGINAL STENOSIS c. ADHESIONS ( SURGICAL)

5. CONTRACTED PELVIS

6. CAUSES IN FETUS: FETAL MACROSOMIA (>4Kg) FETAL MALPOSITION AND MALPRESENTATION. a. OCCIPITO POSTERIOR ( IN PRIMIGRAVIDA COMMON). b. MENTO POSTERIOR c. BREECH d. BROW e. TRANSVERSE LIE

7. 3 . CONGENITAL ANAMOLIES : a. HYDROCEPHALY b. FETAL HYDROPS c. ASCITES d. ABDOMINAL MASSES e. CONJOINT TWINS

8. BEHAVIOUR OF UTERUS IN OBSTRUCTED LABOUR IN PRIMIGRAVIDA IN RESPONSE TO MECHANICAL OBSTTRUCTION IN PRIMIGRAVIDA THE CONTRACTILITY OF UTERUS DECREASES SO IT GOES INTO THE STATE OF UTERINE INERTIA. MOTHER AND FETUS ARE AT THE RISK OF DEATH DUE TO SEPSIS.

9. BEHAVIOUR OF UTERUS IN OBSTRUCTED LABOUR IN MULTIGRAVIDA CONTRACTIONS BECOME MORE AND MORE. THE UPPER SEGMENT OF UTERUS BECOMES THICKER AND THICKER DUE TO CONTRACTION AND REFRACTION WHILE LOWER SEGMENT BECOMES WEAKER AND WEAKER. THE JUNCTION BETWEEN SEGMENTS IS REPRESENTED BY A DEPRESSION CALLED AS BANDL’S RING .

10. CLINICAL FEATURES 1.GENERAL PHYSICAL EXAMINATION MOTHER EXAUSTED / ANXIOUS PAINFUL STATE TACHYCARDIA / FEEBLE PULSE BLOOD PRESSURE ( INCREASED, DECREASED OR NORMAL) DEHYDRATION FOUL SMELLING BREATH SCANTY CONCENTRATED URINE CONTAINING KETONE BODIES / BLOOD.

11. 2 . PER ABDOMEN EXAMINATION INSPECTION: TONICALLY CONTRACTED UTERUS FULL BLADDER BANDL’S RING. PALPATION: UTERUS IS TENDER LIQUOUR ALL DRAINED FETAL PARTS DIFFICULT TO PALPATE. FETAL HEART SOUNDS ABSENT ( DIFFICULT TO AUSCULTATE / ABNORMALITIES IN FETAL HEART SOUNDS)

12. PER VAGINAL EXAMINATION: OEDEMA VULVA DRY HOT VAGINAL MUCOSA CERVIX POORLY APPLIED TO PRESENTING PART CERVIX LOOSELY HANGING /PARTIALLY DILATED MECONIUM DRAINING CAPUT ON PRESENTING PART MOULDING IF UTERUS HAS RUPTURED FETAL PARTS WILL BE PALPABLE IN PERITONEAL CAVITY AND UTERUS IS FELT AS SEPARATE FIRM MASS.

13. COMPLICATIONS: IN FETUS: FETAL ASPHYXIA INTRACRANIAL HAEMORRHAGE PNEUMONIA DUE TO ASCENDING INFECTION FETAL DEATH IN MOTHER: SEPSIS UTERINE RUPTURE POSTPARTUM HAEMORRHAGE HYPOVOLAEMIC SHOCK URINARY OR FECAL FISTULA ANNULAR DETACHMENT OF THE CERVIX

14. MANAGEMENT: ADEQUATE HYDRATION (R/L 1000CC) ADEQUATE ANALGESIA TRIPPLE ANTIBIOTIC COVER CATHETERIZATION ( 3 WEEKS) PREVENTION OF MENDELSON SYNDROME (PASS NASOGASTRIC TUBE/ENSURE GASTRIC EMPTYING 30CC ANTACID MIX 0.5 HR BEFORE SURGERY) CALL TO OPERATION THEATRE/ANAESTHETIST ULTRASOUND SCAN TO CONFIRM FETAL VIABILITY DO ROUTINE INVESTIGATIONS ARRANGE BLOOD

15. TREATMENT: CAESAREAN SECTION .

16. PREVENTION:

17. THANK YOU