Obstructed labour

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

2. COMPLETELY STOPPED
WHEN PROGRESS OF LABOUR IS
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. BONYTUMOURS 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 .
GENITAL TRACT
4.OBSTRUCTION DUE TO LOWER
CONDITIONS:
a. CERVICAL STENOSIS
b. VAGINAL STENOSIS
c. ADHESIONS ( SURGICAL)

6. CONTRACTED PELVIS

7. 1. FETAL MACROSOMIA (>4Kg)
MALPRESENTATION.
( IN PRIMIGRAVIDA
2. FETAL MALPOSITION AND
a. OCCIPITO POSTERIOR
COMMON).
POSTERIOR
b. MENTO
c. BREECH
d. BROW
e. TRANSVERSE LIE

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

10.  IN RESPONSE TO MECHANICAL
IN PRIMIGRAVIDA THE
OBSTTRUCTION
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
AND REFRACTION WHILE LOWER
TO CONTRACTION
SEGMENT
BECOMES WEAKER AND WEAKER.
THE JUNCTION BETWEEN SEGMENTS IS
AS
REPRESENTED BY A DEPRESSION CALLED
BANDL’S RING.

13. 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.

14. 2. PER ABDOMEN EXAMINATION
INSPECTION:
 TONICALLY CONTRACTED UTERUS
 FULL BLADDER
 BANDL’S RING.
PALPATION:
 UTERUS
 LIQUOUR
IS TENDER
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 SEPARATEFIRM MASS.

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

18.  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

19.  CAESAREAN SECTION.

21. THANK YOU