Obstructed labour (dystocia)

1. Obstructed labor
Nur Fadzlina Zabri

2. Definition
It is failure of descent of fetal presenting
part in birth cannal due to mechanical
reasons in spite of good uterine
contractions

3. Incidence
In the developing countries, the
prevalence is about 1–2% in the
referral hospitals

4. Risk factors
 Malnutrition
 Previous caesarean or stillbirth, previous prolonged labour
 Young age of mother (under 17 years of age)
 Female genital mutilation
 Custom of early marriage
 Previous obstructed labour

5. Causes
 Fault in the passage
 Fault in the passenger

6. Fault in the passage:
(1) Bony
◉Contracted pelvis
◉Cephalopelvic disproportion
(2) Soft tissue obstructions:
◉Cervical dystocia due to prolapse or previous operative scarring
◉Broad ligament fibroid
◉Impacted ovarian tumor
◉The non-gravid horn of a bicornuate uterus below the presenting
part.

7. Fault in the passenger:
1) Transverse lie
(2) Brow presentation
(3) Congenital malformations of the fetus—
hydrocephalus (commonest), fetal ascites, double
monsters
(4) Big baby, occipito-posterior position
(5) Compound presentation
(6) Locked twins.

8. Morbid anatomical changes
◉Uterus: formation of Bandl’s ring
◉Bladder: patient fails to empty the bladder. The bladder
walls get traumatized, which may lead to blood stained urine,
a common finding in obstructed labor. The base of the
bladder and urethra, which are nipped in between the
presenting part and symphysis pubis may undergo
pressure necrosis. The devitalized tissue becomes infected
and later on may slough off resulting in the development of
genitourinary fistula.

9. During prolonged labor, compression of
soft tissues between the baby’s head and
the woman’s pelvis cuts off blood flow to
the bladder or rectum. As a result, tissue
dies , leaving hole or fistula

10. Want big impact?
Use big image.
Immediate: Remote:
(1) Exhaustion
(2) Dehydration
(3) Metabolic acidosis
(4) Genital sepsis
(5) Injury to the genital tract
includes rupture of the
uterus
(6) Postpartum hemorrhage
and shock.
(1) Genitourinary fistula or
rectovaginal fistula
(2) Variable degree of vaginal
atresia
(3) Secondary amenorrhoea
following hysterectomy due
to rupture or due to Sheehan’s
syndrome.
Effects on the mother

11. Effects on the fetus
(1) Asphyxia
(2) Acidosis
(3) Intracranial hemorrhage
(4) Infection.
All these lead to increased perinatal loss.

12. Prevention
Antenatal detection of the factors likely
to produce prolonged labor (big baby,
small women, malpresentation and
position).
Intranatal:
Continuous vigilance, use of
partograph and timely intervention of a
prolonged labor due to mechanical
factors can prevent obstructed labor.
Failure in progress of labor in spite of
good uterine contractions for a
reasonable period (2–4 hours) is an
impending sign of obstructed labor

13. Complications
◉Uterine rupture
◉Fistula-faecal, urinary and its psychosocial effects
◉Cervical and vaginal scarring and stenosis Pressure sores and
contractures
◉Foot injury
◉Sepsis
◉PPH, amenorrhea, infertility
◉Fetal loss and maternal death

14. Actual treatment:
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)Fluid electrolyte balance and correction of
dehydration and ketoacidosis
(2)A vaginal swab
(3)Blood sample
(4)Antibiotic

16. Obstetric management:
◉Before proceeding for definitive operative treatment,
rupture of the uterus must be excluded.
◉There is no place of “wait and watch”, neither any scope
of using oxytocin to stimulate uterine contraction.

17. Abdominal delivery
When do we use cs ( abdominal delivery)
• If cephalopelvic disproportion is confirmed
• If precondition for instrumental delivery not
fulfilled
• Malpresention – breech presentation
• Definite uterine rupture

18. Symphysiotomy - rarely used today
◎For relatively mild obstruction
◎If the fetus is alive & cervix is fully dilated
Episiotomy
◎If the cause of obstruction is tight peritoneum
Instrumental delivery
◎ If the fetus is alive, and the cervix is fully dilated and if the head
is at the level of ischial spine or below.
• Forceps
• Vacuum

19. Thanks!

20. References
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