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Obstructed Labour

Obstructed labour occurs when vaginal delivery is mechanically obstructed. It can be caused by maternal factors like a contracted pelvis or fetal issues such as malpresentation. Diagnosis involves a prolonged labour with strong contractions but no progress. Examination reveals a non-engaged presenting part. Management requires immediate termination of labour, typically via Caesarean section, to prevent complications like rupture of the uterus.

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Avinash Barhate
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127 views2 pages

Obstructed Labour

Obstructed labour occurs when vaginal delivery is mechanically obstructed. It can be caused by maternal factors like a contracted pelvis or fetal issues such as malpresentation. Diagnosis involves a prolonged labour with strong contractions but no progress. Examination reveals a non-engaged presenting part. Management requires immediate termination of labour, typically via Caesarean section, to prevent complications like rupture of the uterus.

Uploaded by

Avinash Barhate
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Obstructed Labour

Definition

It is the arrest of vaginal delivery of the foetus due to mechanical obstruction.

Aetiology

Maternal causes

 Bony obstruction: e.g.


o Contracted pelvis.
o Tumours of pelvic bones.
 Soft tissue obstruction:
o Uterus: impacted subserous pedunculated fibroid, constriction ring opposite the neck of the foetus.
o Cervix: cervical dystocia.
o Vagina: septa, stenosis, tumours.
o Ovaries: Impacted ovarian tumours.

Foetal causes

 Malpresentations and malpositions: e.g.


o Persistent occipito-posterior and deep transverse arrest,
o Persistent mento-posterior and transverse arrest of the face presentation.
o Brow,
o Shoulder,
o Impacted frank breech.
 Large sized foetus (macrosomia).
 Congenital anomalies: e.g.
o Hydrocephalus.
o Foetal ascitis.     
o Foetal tumours.
 Locked and conjoined twins.

Diagnosis

It is the clinical picture of obstructed labour with impending rupture uterus (excessive uterine contraction and
retraction).

History

 prolonged labour,
 frequent and strong uterine contractions,
 rupture membranes.

General examination

It shows signs of maternal distress as:

 exhaustion,
 high temperature (³ 38oC),   
 rapid pulse,
 signs of dehydration: dry tongue and cracked lips.
Abdominal examination

 The uterus:
o is hard and tender,
o frequent strong uterine contractions with no relaxation in between (tetanic contractions).
o rising retraction ring is seen and felt as an oblique groove across the abdomen.
 The foetus:
o foetal parts cannot be felt easily.
o FHS are absent or show foetal distress due to interference with the utero-placental blood flow.

Vaginal examination

 Vulva: is oedematous.            
 Vagina: is dry and hot.
 Cervix: is fully or partially dilated, oedematous and hanging.
 The membranes: are ruptured.
 The presenting part: is high and not engaged or impacted in the pelvis. If it is the head it shows excessive
moulding and large caput.
 The cause of obstruction can be detected.

Differential diagnosis

 Constriction ring.  
 Full bladder.
 Fundal myoma.

Complications

 Maternal:
o Maternal distress and ketoacidosis.
o Rupture uterus.
o Necrotic vesico-vaginal fistula.
o Infections as chorioamnionitis and puerperal sepsis.
o Postpartum haemorrhage due to injuries or uterine atony.
 Foetal:
o Asphyxia.       
o Intracranial haemorrhage from excessive moulding.
o Birth injuries.
o Infections.

Management

 Preventive measures:
o Careful observation, proper assessment, early detection and management of the causes of
obstruction.
 Curative measures:
o Caesarean section is the safest method even if the baby is dead as labour must be immediately
terminated and any manipulations may lead to rupture uterus.

Links

 Dystocia : Guidelines, reviews


 Labor, delivery : Guidelines, reviews

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