This document discusses obstructed labour and prolonged labour. Obstructed labour is defined as labour where there is poor or no progress despite good uterine contractions, and is caused by issues with the mother's pelvis or fetus. Prolonged labour is labour lasting over 18 hours. Both conditions can result from problems with the birth passage, passenger, or power of uterine contractions. Management involves general supportive care, obstetric interventions like oxytocics, ARM, forceps, or C-section depending on the stage of labour and specific issues present. Complications can be maternal like rupture, fistula or death, or fetal like asphyxia, injury or death.

1. OBSTRUCTED
LABOUR
Dr Sunitha C
Senior Resident
Department of OBG

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
1.Malpresentation
2.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.

6. Examination
General examination:-
Features of maternal distress i.e.
Exhaustion & keto acidosis
Dehydration
Tachycardia >100/m
Raise temperature
Scanty urine

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.

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.

12. • Curative:-
B.Immediate management
C.General management
D.Obstetric management

13. A. Immediate management :-
1. Correct maternal dehydration
2. Contraction prevent by tocholytic drugs.
3. Blood sample send for grouping and
cross matching.

14. B. General management :-
1.Assessment of vital of mother and general
condition.
2.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.
a. Caesarean section:-
-alive foetus
-over distended lower segment with impending rupture even
the foetus is dead.
1. Active management of 3rd stage of labour.
2.Continuous bladder drainage for 2-3 days to
prevent VVF.

16. Complication
Maternal
-Rupture of uterus
-VVF
-RVF
-PPH
-Puerperal sepsis
-Shock
-Maternal death
Fetal
-intra uterine asphyxia
-Intracranial
haemorrhage
-Neonatal infection
-Acidosis
-Foetal death

17. PROLON
G
LABOUR

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:-
1. Age
2. Parity
3. Duration of labour
4. Duration of membrane rupture
5. Whether the patients was handle outside the
hospital
6. Whether she was treated with oxytocic drugs
outside the hospital
7. 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
1.Frequency, intensity & duration of uterine
contraction.
2.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.

24. Differential diagnosis
* Constriction ring.
* Full bladder.
* Fundal myoma.
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25. 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. Urine should be examine for albumin &
acetone.
6. Blood should be send for grouping and cross
matching.

26. B. Obstetric management :-
• During 1st stage:-
1.Role of oxytocin :- hypotonic uterine contraction
2.Role of sedation :- incase of incordinate uterine
contraction, liberal use of inj. Pethidine 75mg and
inj. Phenargan 25mg IM may lead to spontaneous
correction.
3.Role of ARM:- hypotonic uterine contraction
4.Role of ventouse:- OPP and fetal distress
5.Role of c/s:- contracted pelvis, big baby, mal
presentation, mal position, severe fetal distress.

27. B. During 2nd stage:-
1.Role of episiotomy:- rigid perineum
2.Role of forceps:- fetal distress, DTA, POPP,
cord prolapse in living baby.
3.Role of ventouse:-DTA, OAP,OPP.
4.Role of c/s:- contracted pelvis, big baby, mal
presentation, mal position, severe fetal
distress.
5.Role of destructive operation :- craniotomy,
decapitation, evisceration.

28. Complications
Maternal:-
Immediately:-
-Maternal distress
-Increase operative interference
-Maternal injury
-PPH
-Puerperal sepsis
-Maternal death
Late:-
-Urinary fistula
-Vaginal stenosis
-Asherman’s syndrome
-Secondary infertility
Fetal:-
Immediate:-
-Birth trauma
-Birth asphyxia
-Foetal distress
-Meconium aspiration syndrome
-Still birth
-Neonatal death
Late:-
-Cerebral palsy
- Mental retardation

29. Thankyou!!!!