The document discusses obstructed and prolonged labor, outlining the factors affecting normal labor, early diagnosis of abnormalities, and management strategies for complications. It emphasizes the importance of uterine contractions, maternal pelvis, and fetal size for successful labor, along with signs of complications and various management techniques. Additionally, the document details the potential risks for both mother and fetus associated with prolonged labor and obstructed labor.

1. Obstructed Labor
&
Prolonged Labur

2.  Determine the factors affecting normal labor
 Early diagnosis of abnormal labor
 How to manage abnormal or prolonged labor.
 Identify the complications of prolonged labor.


3. ► Adequate Power (uterine contractions)
► Adequate Passage (maternal pelvis)
► Adequate Passenger (fetal size)
DEFINITION OF PROLONGED
LABOUR
When labor tends to be prolonged for more
than 18 hours both in primigravida and
multigravida women

4. ►Fault in passage
►Fault in passenger
►Fault in power :
▪ Hypotonic Uterine Dysfunction (inertia)
►Can be 2ry to Epidural analgesia or
Chorio amnionitis
▪ Hypertonic / In coordinate Uterine function

5.  History:
 1.Age
 2.Parity
 3.Duration of labor
 4.Duration of membrane rupture
 5.Whether the patients was handle outside the hospital
 6.Whether she was treated with oxytocin drugs
 7.Previous history of difficult labor, instrumental
delivery
or stillbirth

6. Abdominal examination:
1. Contour of the uterus
2. Presentation & position
3. Tenderness
4. Frequency, intensity & duration of uterine
contraction
5. Lower segment distended
6. Distension of the bladder

7. Vaginal examination:
- The vulva usually swollen and edematous.
- The vaginal is dry, hot and occasionally
offensive and purulent discharge
- The cervix is almost fully dilated
- The presenting part is extremely molded
and jammed in the pelvis
- There is usually large caput formation

8. Management
A. General management :
1. NPO & i/v fluid start immediately
2. Bladder evacuation.
3. Parenteral antibiotics.
4. Intake output chart should be strictly maintain
5. Blood should be send for grouping and cross
matching

9. Obstetric Management
During 1st stage:
1. Role of oxytocin : hypotonic uterine contraction
2.Role of sedation : incoordinate uterine contraction use of
narcotics may lead to spontaneous correction
3.Role of amniotomy in correction of hypotonic uterine
contraction
4. Role of cesarean section: contracted pelvis, big baby,
malpresentation, malposition, severe fetal distress

10.  During 2nd stage:
1. Role of episiotomy: rigid / tight perineum
2. Role of instrumental delivery (Forceps or
Vacuum): in case of fetal distress,
 3. Role of cesarean section: contracted pelvis,
big baby, malpresentation, malposition, and
severe fetal distress

11. Fetal:
Immediate:
- Birth trauma
- Birth asphyxia
- Fetal distress
- Meconium aspiration
syndrome
- Stillbirth
- Neonatal death
!
Late:
- Cerebral palsy
- Mental retardation
Maternal:
Immediately:
-Maternal distress
-Maternal injury
-PPH
-Puerperal sepsis
-Maternal death
!
Late:-
-Urinary fistula
-Vaginal stenosis
-Secondary infertility
Complications

12. Obstructed labour
►Definition : defined as labor where there is poor or
no progress of labor in spite of good uterine
contraction!
►Incidence :- 1 -2% of cases in developing country

13. Causes
►Maternal condition (fault in the passage):
1. Contracted pelvis
2. Abnormal pelvis: android, anthropoid
3. Pelvic tumor: fibroid, ovarian tumor
4. Tumor of rectum, bladder or pelvic bone
5. Abnormality in uterus & vagina: scarring in cervix, vaginal
septum, rigid perineum

14. fetal causes
Big baby
Big head, hydrocephalus
Deflexed head, brow and face
mentoposterior.
Oblique or transverse lie


15.  Diagnosis
►Partogram will recognize impending
obstruction of labor
►Careful general, abdominal and vaginal
examination can detect if labor is slow or
no progress

16.  General examination:
 Features of maternal distress
 Dehydration
 Tachycardia >100/m
 Raise temperature
 Scanty urine

17.  Abdominal examination :
 -The retraction ring might appear and felt
 between the tonic contracted upper
 segment of the uterus and the distended
 lower segment
 - Distended urinary bladder

19.  Vaginal examination:
- The vulva usually swollen and edematous
- The vaginal can be dry and hot
- The cervix is almost fully dilated or hanging
like a curtain
- The presenting part is extremely molded
and jammed in the pelvis
- There is usually large caput formation

20. Maternal:
!
-Rupture of uterus
-Urogenital fistula
-Rectovaginal fistula
-Postpartum hemorrhage
-Puerperal sepsis
-Shock
-Maternal death
Fetal:
!
-Intra uterine asphyxia
-Intracranial hemorrhage
-Neonatal infection
-Metabolic Acidosis
-Fetal death
Complication

21.  Management
►Preventive:
- Proper assessment of pregnant woman during ANC
- Regular ANC visit
- Proper assessment in early labor to
- Use of Partogram
- Prompt and appropriate treatment

22. Obstetric Management
1. Delivery of fetus:
a. Vaginal delivery: if head is low and vaginal delivery
is not risky, forceps extraction may be done
b. Caesarean section:
2. Active management of 3rd stage of labor
3. Continuous bladder drainage for 2-3 days to
prevent any urogenital fistula