Obstructed Labour

Obstructed Labour

Labour is said to be obstructed when there is no advancement of the presenting part. Usually it occurs at the brim but may occur at the outlet or deep transverse arrest in android pelvis.

Causes

CPD, deep Transverse arrest, fetal abnormalities – hydrocephalic fetus, locked twins, mal-presentation, pelvic tumours.

S & S

Early signs are non-engagement of head despite contraction., Slow dilatation, of the Cervix late signs are Dehydration, Ketosis, Severe pain, Rapid pulse, Low & concentrated urine, Fetal distress, Tonic contraction of the uterus – Abnormal uterine action , Bandl’s Ring, Vaginal is hot and dry, High presenting part, Excessive moulding and caput-succedaneun

Management

I.V infusion to correct dehydration, Antibiotic, Rotation and deliver by forceps or vacuum, C/S, Resuscitate asphyxiated baby.

Complications

Maternal Infection - injuries to bladder, ruptured uterus, hemorrhage, maternal death, Fetal - hypoxia, still birth, permanent brain damage, intracranial hemorrhage, neonatal pneumonia.

Prevention

·              Proper history taking of previous deliveries e.g. prolonged labor, big baby etc.

·              Correct mal-presentation early, pelvic assessment at 36 wks. Careful monitoring of descent in labour ,

·              Timely medical Aids; ceasarean section.