Obstructed labour occurs when the vaginal delivery of the fetus is arrested due to a mechanical obstruction. It can be caused by maternal factors like a contracted pelvis or fetal macrosomia. Diagnosis involves a clinical examination showing signs of maternal distress, frequent contractions with no relaxation, and an inability to feel or engage the fetal presenting part. Management involves preventative measures and early detection of potential obstructions, as well as curative measures like caesarean section to immediately terminate labour and prevent complications like rupture of the uterus.

1. Obstructed Labourwww.freelivedoctor.com

2. Obstructed LabourDefinitionIt is the arrest of vaginal delivery of the foetus due to mechanical obstruction.www.freelivedoctor.com

3. AetiologyMaternal causesa.Bony obstruction: e.g.> Contracted pelvis. > Tumours of pelvic bones.b.Soft tissue obstruction:>Uterus: impacted subserouspedunculated fibroid, constriction ring opposite the neck of the foetus.> Cervix: cervical dystocia.> Vagina: septa, stenosis, tumours.>Ovaries: Impacted ovarian tumours.www.freelivedoctor.com

4. AetiologyFoetal causes:a.Malpresentations and malpositions: e.g.> Persistent occipito-posterior and deep transverse arrest,>Persistent mento-posterior and transverse arrest of the face presentation.>Brow,> Shoulder,>Impacted frank breech.b.Large sized foetus (macrosomia).c.Congenital anomalies: e.g.> Hydrocephalus.> Foetalascitis. >Foetaltumours.d. Locked and conjoined twins.www.freelivedoctor.com

5. DiagnosisIt is the clinical picture of obstructed labour with impending rupture uterus (excessive uterine contraction and retraction).www.freelivedoctor.com

6. History * prolonged labour,* frequent and strong uterine contractions,* rupture membranes.www.freelivedoctor.com

7. General examinationIt shows signs of maternal distress as:* exhaustion,* high temperature (³ 38oC), * rapid pulse,* signs of dehydration: dry tongue and cracked lips.www.freelivedoctor.com

8. Abdominal examination* The uterus:> is hard and tender,>frequent strong uterine contractions with no relaxation in between (tetanic contractions).>rising retraction ring is seen and felt as an oblique groove across the abdomen.* The foetus:>foetal parts cannot be felt easily.>FHS are absent or show foetal distress due to interference with the utero-placental blood flow.www.freelivedoctor.com

9. Vaginal examination* Vulva: is oedematous. * Vagina: is dry and hot.* Cervix: is fully or partially dilated, oedematous and hanging.* The membranes: are ruptured.*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.* The cause of obstruction can be detected.www.freelivedoctor.com

10. Differential diagnosis* Constriction ring. * Full bladder.* Fundalmyoma.www.freelivedoctor.com

11. Complicationsa.Maternal:> Maternal distress and ketoacidosis.> Rupture uterus.> Necrotic vesico-vaginal fistula.> Infections as chorioamnionitis and puerperal sepsis.> Postpartum haemorrhage due to injuries or uterine atony.www.freelivedoctor.com

12. Complicationsb. Foetal:> Asphyxia. > Intracranial haemorrhage from excessive moulding.> Birth injuries.> Infectionswww.freelivedoctor.com

13. ManagementPreventive measures:>Careful observation, proper assessment, early detection and management of the causes of obstruction.Curative measures:> 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.www.freelivedoctor.com