Table Of Contents
Obstructed Labor
Obstructed labour refers to failure of descent of the presenting part despite strong uterine contractions, often due to mechanical obstruction. It is a life-threatening obstetric emergency that can lead to uterine rupture, fetal death and maternal complications suchs as fistula, hemorrhage and sepsis.
Diagnosis of obstructed labour
| Component | Features |
|---|---|
| Prolonged labour | > 12 – 24 hours with strong, frequent contraction, no progress in cervical dilation or fetal descent |
| Evidence of obstruction | Caput, moulding, asynclytism, persistent occiput posterior, brow or shoulder presentation, pelvic deformity or fetal macrosomia |
| Clinical signs of complications | Bandl’s ring, maternal exhuastion and dehydration, fetal distress |
- Causes of obstructed labor
- Cephalopelvic disproportion (> 65%)
- Malpresentation (e.g. breech, shoulder, brow and face)
- Transverse lie
- Hydrocephalus
- Locked twins
- Pelvic tumor (e.g. fibroid, ovarian cyst)
- Stenosis of the vagina
- 3 delays
- Delayed decision to seek care
- Delayed transfer to health facility
- Delayed access to adequate care
- Patient history
- Prolonged labour (> 12 – 18 hours)
- Prolonged rupture of membranes
- Failure of descent despite good contractions
- Signs and symptoms of obstructed labor
- Dehydration e.g. sunken eyes, dry mucosa
- Tachycardia and hypotension
- Fever
- Pallor
- Ketotic breath (due to startvation ketosis)
- Hypertonc or tender uterus
- Bandl’s ring (pathological retraction ring due to stretching of the lower segment)
- Fetal parts easily palpable (due to thinning of the utreus)
- Fetal bradycardia or tachycardia
- Severe moulding or caput
- Dry and hot vagina with foul-smelling discharge
- Thick, edematous cervix that is partially dilated or not dilating further
- High station
- Bloody urine via foley catheter
- Treatment
- ABCs
- IV fluids
- Oxygen
- Foley catheter of urine output
- Caesarean delivery
- Destructive procedure (craniotomy, decapitation, or eviscaration) if the fetus is not viable and caesarean delivery is not faesible
- ABCs
- Maternal complications of obstructed labour
- Uterine rupture
- Postpartum hemorrhage
- Puerperal sepsis
- Vesicovaginal or rectovaginal fistula (VVF and RVF)
- Pelvic abscess
- Foot drop (due to lumbosacral nerve compression
- Maternal death
- Fetal complications of obstructed labour
- Stillbirth
- Hypoxic-ischemic encephalopathy
- Intracranial hemorrhage
- Birth trauma
- Neonatal sepsis
