This document discusses obstructed labor, defined as arrested progression of the presenting fetal part during labor due to mechanical obstruction. Causes include faults in the pelvic passageway or fetus. Anatomical changes in the mother include pathological retraction rings and trauma to organs. Effects on the mother are immediate like exhaustion, infection, and hemorrhage or remote like fistulas. The fetus is at risk of asphyxia, infection, and acidosis. Clinical features include continuous pain, exhaustion, tender abdomen, and swollen vagina. Prevention focuses on antenatal detection and timely intervention in prolonged labor. Treatment principles are to relieve the obstruction, combat dehydration and infection, and control sepsis through fluid resuscitation, antibiotics,

1. OBSTRUCTED LABOUR
DR.RUPAL

2. DEFINITION
Inspite of good
uterine
contractions
Progressive descent
of presenting part-
arrested
Due to mechanical
obstruction

3. CAUSES
FAULT IN
PAASAGE
BONY
SOFT TISSUE
OBSTRUCTIONS
FAULT IN
PASSENGER
TRANSVERSE LIE
BROW PRESENTATION
OCCIPITOPOSTERIOR
BIG BABY
MULTIPLE PREGNANCY
CONGENITAL
ANOMALIES OF FETUS

4. ANATOMICAL CHANGES
• PATHOLOGICAL RETRACTION
RING/BANDL’S RING
UTERUS
• ABDOMINAL ORGAN
• TRAUMATISED-blood stained
urine
• Pressure necrosis
• Genitourinary fistula
BLADDER

5. EFFECTS ON MOTHER
IMMEDIATE
• Exhaustion
• Dehydration
• Metabolic acidosis is due to
accumulation of lactic acid and
ketones.
• Genital sepsis
• Injury to the genital tract includes
rupture of the uterus
• Postpartum hemorrhage and
shock
• The deaths are due to rupture of
the uterus, shock and sepsis with
metabolic changes.
REMOTE
• Genitourinary fistula or
rectovaginal fistula
• Secondary amenorrhoea
following hysterectomy due to
rupture or due to sheehan’s
syndrome.

6. EFFECTS ON FETUS
ASPHYXIA
ICH
ACIDOSIS
INFECTION

7. CLINICAL FEATURES
• Patient is in agony from continuous pain and discomfort and
becomes rest-less
• Features of exhaustion and ketoacidosis.
• Abdominal palpation reveals—
(a) Upper segment is hard and tender (b)Lower segment is
distended and tender.(c) Distended bladder
Vaginal examination:-- Vulva usually swollen and edematous,
vaginal is dry, hot and occasionally offensive and purulent
discharge. Cervix is almost fully dilated or hanging like a curtain.-
The presenting part is extremely moulded and jammed in the
pelvis. Large caput formation.

8. PREVENTION
Antenatal detection factors -
prolonged labor (big baby, small
women,malpresentation and
position).
Intranatal: use of partograph and
timely intervention - prolonged labor
due to mechanical factors
Failure in progress of labor in spite of
good uterinecontractions - reasonable
period (2–4 hours) is an impending
sign of obstructed labor.

9. PRINCIPLES OF TREATMENT
Relieve the
obstruction
Combat
dehydration and
ketoacidosis
control sepsis

10. IMMEDIATE MANAGEMENT
• Fluid
electrolyte
balance and
correction of
dehydration
and
ketoacidosis
• vaginal swab-
culture and
sensitivity
test.
• Blood sample
is sent for
group and
cross
matching.
• Antibiotic:
ceftriaxone 1
g IV is
administered.
(5) IV infusion,
metronidazole
is given for
anaerobic
infection

11. OBSTETRIC MANAGEMENT
VAGINAL
DELIVERY
CAESAREAN
SECTION

12. THANK YOU