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.
Cephalopelvic disproportion (CPD) is a pregnancy complication that may interferes with vaginal delivery; making it dangerous or impossible and requires caeserean section.
Cephalopelvic disproportion (CPD) is a pregnancy complication that may interferes with vaginal delivery; making it dangerous or impossible and requires caeserean section.
Hydatidiform Mole (HM) is a rare mass or growth that forms inside the uterus at the beginning of a pregnancy. It is a type of gestational trophoblastic disease (GTD).
When a normal sperm cell fertilizes one of these oocytes, the resulting embryo has only one set of chromosomes. Because the embryo has no genes from the mother, the pregnancy cannot develop normally, resulting in a hydatidiform mole.
This topic contains detailed description about labour, its definition, date of onset of labour, calculations of date of delivery, causes of onset of labour, physiology of normal labour, and events, clinical course and management of each stages of labour.
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
Hydatidiform Mole (HM) is a rare mass or growth that forms inside the uterus at the beginning of a pregnancy. It is a type of gestational trophoblastic disease (GTD).
When a normal sperm cell fertilizes one of these oocytes, the resulting embryo has only one set of chromosomes. Because the embryo has no genes from the mother, the pregnancy cannot develop normally, resulting in a hydatidiform mole.
This topic contains detailed description about labour, its definition, date of onset of labour, calculations of date of delivery, causes of onset of labour, physiology of normal labour, and events, clinical course and management of each stages of labour.
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
2. Obstructed Labour Definition It is the arrest of vaginal delivery of the foetus due to mechanical obstruction. www.freelivedoctor.com
3. Aetiology Maternal causes a.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. Aetiology Foetal 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. Diagnosis It 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 examination It 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
11. Complications a.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. Complications b. Foetal: > Asphyxia. > Intracranial haemorrhage from excessive moulding. > Birth injuries. > Infections www.freelivedoctor.com
13. Management Preventive 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