2. “ Obstructed labour is one where
inspite of good uterine contractions, the
progressive descent of the presenting
part is arrested due to mechanical
obstruction.”
This may result either due to factors in
the fetus or in the birth canal or both,
so that further progress is almost
impossible without assistance.
3. In the developing countries, the
prevalence is about 1-2 % in the referral
hospitals.
5. 1. BONY
Cephalo pelvic disproportion and
contracted pelvis are the common
causes.
Secondary contracted pelvis may be
encountered in multiparous women.
6. 2. SOFT TISSUE OBSTRUCTION
This includes cervical dystocia due to
prolapse or previous operative
scarring, cervical or broad ligament
fibroid, impacted ovarian tumor or the
non-gravid horn of a bicornuate uterus
below the presenting part.
7. Transverse lie
Brow presentation
Congenital malformations of the fetus-
hydrocephalus ( commonest), fetal
ascites, double monsters
Big baby, occipito-posterior position
Compound presentation
Locked twins
9. REMOTE:
Even if the patient survives, the following
legacies may be left behind:
1. Genito-urinary fistula or rectovaginal
fistula
2. Variable degree of vaginal atresia
3. Secondary amenorrhoea following
hysterectomy due to rupture or due to
Sheehan's syndrome (pitutary gland
damage during childbirth)
11. Patient is in agony
Features of exaustion
On abdominal examination:- upper
segment is hard and tender, lower
segment is distended and tender.
12. Antenatal detection of the factors likely
to produce prolonged labor. ( big baby,
small women, malpresentation and
position)
Intranatal: Continuous vigilence, use of
partograph and timely intervention of a
prolonged labour due to mechanical
factors can prevent obstructed labour.
13. Failure in progress of labour inspite of
good uterine contractions for a
reasonable period ( 2-4 hours) is an
impending sign of obstructed labour.
14. The underlying principles are:
1. To relieve the obstruction at the earliest
by a safe delivery procedure.
2. To combat dehydration and ketoacidosis
3. To control sepsis
15. PRELIMINARIES
1. Fuild electrolyte balance and
correction of dehydration and
ketoacidosis.
2. A vaginal swab tissue culture and
sensitivity test
3. Blood examination
4. Antibiotic: 1 g cefriaxone IV
5. Metronidazole for IV for anaerobic
infection
16. Before proceeding for definitive operative
treatment, rupture of the uterus must be
excluded.
A balanced decision should be taken
about the best method of relieving the
obstruction with least hazards to the
mother.
Frantic attempt to deliver a moribund
(dying) baby by a method ignoring the risk
involved to the risk involved to the mother
is indeed bad obstetricss.
17. There is no place of “wait and watch”,
neither is any scope of using oxytocin
to stimulate uterin contraction.
18. Baby is invariably dead in most of the
neglected cases and destructive
operation is the best choice to relive
the obstruction.
If however, the head is low down and
vaginal delivery is not risky, forceps
extraction may be done in a living baby.
There no place of internal version in
obstructed labour.
19. After complition of the delivery and
expulsion of the placenta, exploration
of the uterus and the lower genital tract
should be done to exclude uterine
rupture or tear.
20. If the case is detected early with good
fetal condition, cesarean section gives
the best result.
But in late or neglected cases, even if
the fetal heart sound is audible,
desperate attempt to do a cesarean
section to save moribund baby more
often leads to disastrous consequences
21. Not infrequently, the baby is either
delivered stillborn or dies neonatal
sepsis.
The postoperative period of the mother
also becomes stormy and at times,
ends fatally.
22. The place of symphysiotomy has to be
duly considered in the developing
countries as an alternative to risky
cesarean section.
This can be dine in a case of
eshtablished obstruction due to outlet
contraction with vertex presentation
having good FHS.
