2. WHEN PROGRESS OF LABOUR IS
COMPLETELY STOPPED DESPITE
STRONG UTERINE CONTRACTIONS .
3. DISPROPORTION BETWEEN DIAMETER OF BIRTH CANAL AND FETUS.
CAUSES IN MOTHER:
1. CONTRACTED PELVIS (DEVELOPMENTAL, METABOLIC OR
TRAUMATIC)
2. 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)
7. 1. FETAL MACROSOMIA (>4Kg)
2. FETAL MALPOSITION AND MALPRESENTATION.
a. OCCIPITO POSTERIOR ( IN PRIMIGRAVIDA
COMMON).
b. MENTO POSTERIOR
c. BREECH
d. BROW
e. TRANSVERSE LIE
10. 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.
11. 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.
14. 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)
15. 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.
16.
17. 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