Obstructed labour

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Obstructed labour

  1. 1. Obstructed Labour<br />www.freelivedoctor.com<br />
  2. 2. Obstructed Labour<br />Definition<br />It is the arrest of vaginal delivery of the foetus due to mechanical obstruction.<br />www.freelivedoctor.com<br />
  3. 3. Aetiology<br />Maternal causes<br />a.Bony obstruction: e.g.<br />> Contracted pelvis.<br /> > Tumours of pelvic bones.<br />b.Soft tissue obstruction:<br />>Uterus: impacted subserouspedunculated fibroid, constriction ring opposite the neck of the foetus.<br />> Cervix: cervical dystocia.<br />> Vagina: septa, stenosis, tumours.<br />>Ovaries: Impacted ovarian tumours.<br />www.freelivedoctor.com<br />
  4. 4. Aetiology<br />Foetal causes:<br />a.Malpresentations and malpositions: e.g.<br />> Persistent occipito-posterior and deep transverse arrest,<br />>Persistent mento-posterior and transverse arrest of the face presentation.<br />>Brow,<br />> Shoulder,<br />>Impacted frank breech.<br />b.Large sized foetus (macrosomia).<br />c.Congenital anomalies: e.g.<br />> Hydrocephalus.<br />> Foetalascitis. <br />>Foetaltumours.<br />d. Locked and conjoined twins.<br />www.freelivedoctor.com<br />
  5. 5. Diagnosis<br />It is the clinical picture of obstructed labour with impending rupture uterus (excessive uterine contraction and retraction).<br />www.freelivedoctor.com<br />
  6. 6. History<br /> * prolonged labour,<br />* frequent and strong uterine contractions,<br />* rupture membranes.<br />www.freelivedoctor.com<br />
  7. 7. General examination<br />It shows signs of maternal distress as:<br />* exhaustion,<br />* high temperature (³ 38oC), <br />* rapid pulse,<br />* signs of dehydration: dry tongue and cracked lips.<br />www.freelivedoctor.com<br />
  8. 8. Abdominal examination<br />* The uterus:<br />> is hard and tender,<br />>frequent strong uterine contractions with no relaxation in between (tetanic contractions).<br />>rising retraction ring is seen and felt as an oblique groove across the abdomen.<br />* The foetus:<br />>foetal parts cannot be felt easily.<br />>FHS are absent or show foetal distress due to interference with the utero-placental blood flow.<br />www.freelivedoctor.com<br />
  9. 9. Vaginal examination<br />* Vulva: is oedematous. <br />* Vagina: is dry and hot.<br />* Cervix: is fully or partially dilated, oedematous and hanging.<br />* The membranes: are ruptured.<br />*The presenting part: is high and not engaged or impacted in the pelvis. If it is the head it shows excessive moulding and large caput.<br />* The cause of obstruction can be detected.<br />www.freelivedoctor.com<br />
  10. 10. Differential diagnosis<br />* Constriction ring. <br />* Full bladder.<br />* Fundalmyoma.<br />www.freelivedoctor.com<br />
  11. 11. Complications<br />a.Maternal:<br />> Maternal distress and ketoacidosis.<br />> Rupture uterus.<br />> Necrotic vesico-vaginal fistula.<br />> Infections as chorioamnionitis and puerperal sepsis.<br />> Postpartum haemorrhage due to injuries or uterine atony.<br />www.freelivedoctor.com<br />
  12. 12. Complications<br />b. Foetal:<br />> Asphyxia. <br />> Intracranial haemorrhage from excessive moulding.<br />> Birth injuries.<br />> Infections<br />www.freelivedoctor.com<br />
  13. 13. Management<br />Preventive measures:<br />>Careful observation, proper assessment, early detection and management of the causes of obstruction.<br />Curative measures:<br />> Caesarean section is the safest method even if the baby is dead as labour must be immediately terminated and any manipulations may lead to rupture uterus.<br />www.freelivedoctor.com<br />

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