2. Obstructed labour
• Definition :- obstructed labour can be
define as a labour where there is poor or
no progress of labour in spite of good
uterine contraction.
• Incidence :- 1 -2% of referral cases in
developing country.
3. Causes:-
•Maternal condition (fault in the passage):-
2.Contracted pelvis
3.Abnormal pelvis:- android, anthropoid
4.Pelvic tumor:- fibroid, ovarian tumor
5.Tumor of rectum, bladder or pelvic bone.
6.Abnormality in uterus & vagina:-stenosis in
cx. & vagina, contraction ring in uterus,
vaginal septum, rigid perineum.
4. •Foetal condition (fault in the passenger):-
2.Macrosomic baby
3.Malpresentation
4.Malposition:- popp, transverse lie
5.Malformed foetus:- hydrocephalus, foetal
Ascitis, conjoint twins, cord around the
neck.
6.Locked twins
5. Diagnosis
• Partograph will recognize impending
obstruction early. If the labour is slow to
progress, careful general, abdominal and
vaginal examination is necessary.
• Woman gives the history of:-
-prolong labour and
-the labour pain become severe and frequent
and
-bearing down.
7. Abdominal examination :-
-The retraction ring (bandl’s ring) is seen
and felt between the tonically contracted
upper segment of the uterus and the
distended , tender and stretched lower
segment.
- Distended urinary bladder.
- FHS shows evidence of foetal distress or
even absent.
8.
9.
10. 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 or hanging
like a curtain.
- The presenting part is extremely moulded
and jammed in the pelvis.
- There is usually large caput formation.
11. Management
• Preventive:-
- Proper assessment of pregnant woman
during ANC.
- Regular ANC visit.
- Proper assessment in early labour to detect
the cause if any.
- Partograph have to strictly follow.
- Prompt follow appropriate treatment to solve
the problems.
13. A. Immediate management :-
2. Correct maternal dehydration
3. Contraction prevent by tocholytic drugs.
4. Blood sample send for grouping and
cross matching.
14. B. General management :-
2.Assessment of vital of mother and general
condition.
3.IV fluid to correct dehydration.
4.Broad spectrum antibiotics.
5.Catheterization.
6.Sodium bicarbonate infusion to correct
acidosis.
15. C. Obstetric management:-
1. Delivery of foetus:-
a. Vaginal delivery:-
-(destructive opt.) dead foetus
-if head is low and vaginal delivery is not risky, forceps
extraction may be done in alive foetus also.
b. Caesarean section:-
-alive foetus
-over distended lower segment with impending rupture even
the foetus is dead.
2. Active management of 3rd stage of labour.
3.Continuous bladder drainage for 2-3 days to
prevent VVF.
18. • When labour tends to be prolonged for
more than 18 hours both in primi gravida
and multi gravida is called prolonged
labour.
19. Causes
• Fault in passage
• Fault in passenger
• Fault in power :-
- hypotonic uterine contraction
- uncoordinated uterine contraction
- Constriction ring
- Cervical dystocia
20. Diagnosis
A. History:-
2. Age
3. Parity
4. Duration of labour
5. Duration of membrane rupture
6. Whether the patients was handle outside the
hospital
7. Whether she was treated with oxytocic drugs
outside the hospital
8. Previous history of difficult labour, instrumental
delivery or stillbirth.
21. B. General examination :-
2.Height of patients
3.Dehydration
4.Acetone breath
5.Pallor
6.Raise in temperature
7.Tachycardia
8.Decrease in BP
22. C. Abdominal examination :-
2.Contour of the uterus
3.Presentation & position
4.Tenderness
5.Frequency, intensity & duration of uterine
contraction.
6.Lower segment distended or not.
7.Distension of the bladder.
8.Fetal heart sound.
23. 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 or hanging
like a curtain.
- The presenting part is extremely moulded
and jammed in the pelvis.
- There is usually large caput formation.
25. Management
A. General management :-
2. NPO & i/v fluid start immediately.
3. Bladder evacuation.
4. Parenteral antibiotics.
5. Intake output chart should be strictly
maintain.
6. Urine should be examine for albumin &
acetone.
7. Blood should be send for grouping and cross
matching.
26. B. Obstetric management :-
• During 1st stage:-
3.Role of oxytocin :- hypotonic uterine contraction
4.Role of sedation :- incase of incordinate uterine
contraction, liberal use of inj. Pethidine 75mg and
inj. Phenargan 25mg IM may lead to spontaneous
correction.
5.Role of ARM:- hypotonic uterine contraction
6.Role of ventouse:- OPP and fetal distress
7.Role of c/s:- contracted pelvis, big baby, mal
presentation, mal position, severe fetal distress.
27. B. During 2nd stage:-
2.Role of episiotomy:- rigid perineum
3.Role of forceps:- fetal distress, DTA, POPP,
cord prolapse in living baby.
4.Role of ventouse:-DTA, OAP,OPP.
5.Role of c/s:- contracted pelvis, big baby, mal
presentation, mal position, severe fetal
distress.
6.Role of destructive operation :- craniotomy,
decapitation, evisceration.
