Obstructed labour comprises one of the five major causes of maternal mortality and morbidity in developing countries 3, 4. Obstructed labour also causes significant maternal morbidity in the short term notably. Without intervention, obstruction leads to pressure necrosis and fetal death. Obstructed labour contributes significantly to the morbidity and mortality. The major cause of obstructed labor is cephalopelvic disproportion, which may be due to a small pelvis, a large baby, fetal malpresentation, a tight perineum, or abnormalities or tumors of the uterus, ovary, or vagina. The incidence of obstructed labour was much higher for the unbooked patients 33 % than for the booked patients 1. This study was conducted to find out the incidence of uterine rupture particularly in the patients of obstructed labour ol, foetomaternal. A woman is probably in obstructed labour if she has been laboring for twelve hours with strong regular contractions with no progression to delivery prolonged labour. She continued that obstructed labour leads to vvf when prolonged and unrelieved pressure on the womans pelvic wall causes a puncture in the bladder. This article is part of a series of continuing education activities in this journal through which a total of 36 amapra category 1 creditstm can be earned in 2007.
The need for revival of symphysiotomy in nigeria emmanuel monjok 1, 2, 6, ita b. Obstructed labour passage when the pelvis of the mother is too small, or the passage through which the baby is to come out is small for babys head to pass through the labour is prolonged. Normal labour definitions labour series of events that take place in the genital organs in an effort to expel the viable products of conception out of the womb through the vagina into the outer world. Delivery the expulsion or extraction of a viable fetus out of the womb. Obstructed labor is an important cause of maternal and perinatal mortality and morbidity. The number of maternal deaths as a result of obstructed labor is 8% globally but this number varies in developing country, it ranges 470% of all maternal deaths and it is also. Bipedalism, encephalization, and the human obstetric dilemma anna blackburn wittman, ma, and l. A free powerpoint ppt presentation displayed as a flash slide show on id. Fetal and maternal outcomes of mothers presenting with. Here you can read posts from all over the web from people who wrote about fistula and obstructed labour, and check the relations between fistula and obstructed labour. Pdf maternofetal outcome in obstructed labour in a tertiary care. Chapter 1 cephalopelvic disproportion an overview this chapter defines cephalopelvic disproportion cpd and briefly describes how it is diagnosed during a trial of labour.
Risk factors for obstructed labour in eastern uganda. No epidemiological study has documented the risk factors for ol in eastern uganda. She will be exhausted and there will be poor descent of the head even if the cervix is dilated. Obstructed labor definition of obstructed labor by the free. Primigravid mothers may be more at risk of dystocia as they have a degree of uterine uncoordination which is why their labours tend to be longer. Incidence and management of obstructed labour in eastern. These materials have been compiled into an extensive digital archive, which includes curricula and training modules for health care workers, evaluation and research reports, journal articles, project and meeting reports, technical briefs, and tools. Oxytocin can enhance and coordinate uterine contractions.
Open access research prevalence of pregnancyrelated. An obstetric labor complication is a difficulty or abnormality that arises during the process of labor or delivery the trust for americas health reports that as of 2011, about one third of american births have some complications. Obstructive labor pdf university of toronto department of. Is the failure of the fetus to descend through the birth canal, because there is a barrier obstruction pre. Obstructed labour, causes, complications ask a gynecologist.
Cephalopeivic disproportion was the greatest cause of obstructed labour 67%, while caesarean section was the main method of delivery 85%. Labour is considered obstructed when the presenting part of the fetus cannot progress into the birth canal, despite strong uterine contractions. The partograph graphically represents key events in labor and provides an early warning system. Incidence, causes and outcome of obstructed labor in jimma. Obstructed labour is an important cause of maternal deaths in communities in which undernutrition in childhood is common resulting in small pelves in women, and in which there is no easy access to. Prolonged obstructed labour catherine emmerson fffp, frcog consultant, sunderland royal hospital, uk honorary clinical senior lecturer, newcastle medical school, uk. Fourth edition of the alarm international program management of labour and obstructed labour chapter 4 page 3 a vaginal examination should be carried out in 3 hours, then in 2 more hours and every 2 hours thereafter. To assess and improve the management of obstructed labour in maternity units in malawi.
Global burden of obstructed labour in the year 2000. One of your major roles as a skilled birth attendant is to prevent the occurrence of obstructed labour in women in your community. Managing prolonged and obstructed labor reprolineplus. Obstructed labour definition of obstructed labour by. The use of the following definition and duration of the second stage of labour is recommended for practice. Delivery of the impacted head of the fetus at caesarean. A criterion based audit of the management of obstructed labour was conducted in 8 hospitals in three districts in malawi. Introduction to improve maternal and fetal outcomes among patients with obstructed labour ol in lowresource settings, the associated electrolyte and metabolic derangements must be adequately corrected. Physical or mental exertion, especially when difficult or exhausting. Training course in sexual and reproductive health research 2010. Who recommendation on definition and duration of the. Prevention antenatal detection factors prolonged labor big baby, small women,malpresentation and position. Fourth edition of the alarm international program chapter 4 page 2 management of labour and obstructed labour use of the partograph in labour why the partograph.
Obstructed labour is a common obstetric complication in nigeria associated with poor fetal and maternal outcome. Labour dystocia is the leading cause of interventions during delivery. Combining group interaction with the pursuit of new ideas through gt. The following types of abnormal labor may occur at any point during the three stages of labor. Who midwifery education module 3 managing prolonged and. Complications of prolonged obstructed labour for both mother and baby are many and include. The skills specific to preventing and managing prolonged and obstructed labour include. In our case, we assumed that the cephalic ulcers in the baby were caused by pressure necrosis because the localisation of the ulcers on the fetal head correspond to the position of the head in relation to the pelvic brim. Obstructed labour is the failure of the fetus to descend through the birth canal, because there is an impossible barrier obstruction preventing its descent despite strong uterine contractions. Lewis wall, md, dphil doctoral student in anthropology, professor, department of anthropology. The previous fistula care project 200720 developed a wealth of resources, educational materials, research reports, and journal articles. The mode of delivery at caesarean section may occasionally compound the morbidity associated with obstructed labour. It is important to educate people in rural areas about the importance of getting skilled care at every delivery.
Prevalence and associated factors of obstructed labour, and its outcome among mothers delivered at gimbi public hospital, wollega, western ethiopia 285 operational and term definitions obstructed labour. Module 5 prevention of prolongued and obstructed labor. Definition obstructed labour can be define as a labour where there is poor or no progress of labour in spite of good uterine contraction. The obstruction usually occurs at the pelvic brim, but occasionally it may occur in the pelvic cavity or at the outlet of the pelvis. Prolonged labour or obstructed labour occurs when the fetus does not progress into the birth canal despite strong uterine contractions. If your baby is not born after approximately 20 hours of regular. Obstructed labour with ruptured uterus is a serious obstetrical complication with a high incidence of maternal and foetal morbidity and mortality. Other terms used equally for labour dystocia are prolonged labour, difficult labour, dysfunctional labour, failure to progress, cephalopelvic disproportion cpd and obstructed labour. Cephalopelvic disproportion cpd means it is difficult or impossible for the fetus to pass safely through the mothers pelvis due either to a maternal pelvis that is too narrow for that fetal head, or a large fetal head relative to that mothers pelvis see figure 9. Instructions for how cme credits can be earned appear on the last page of the table of contents. Risk factors for ol and its associated obstetric squeal are usually context specific. Obstructed labour is a major cause of maternal death and disability. Prolonged labor can be determined by labor stage and whether the cervix has thinned and opened appropriately during labor.
Open access research article prevalence and associated. This draft paper summarizes the data and methods used to produce. Obstruction usually occurs at the pelvic brim, but occasionally it may occur in the cavity or at the outlet of the pelvis. Who safe childbirth checklist implementation guide 8 background and overview childbirth is a complex process with many necessary, sometimes difficult, sometimes complicated steps that ensure both the mother and her newborn child receive the safest care possible.
It is the clinical picture of obstructed labour with impending rupture uterus excessive uterine contraction and retraction. Obstructed labour is a major cause of maternal and perinatal morbidity and mortality. Oral fluid intake during labour and preoperative intravenous fluid replacement following ol corrects the associated dehydration and electrolyte changes, but it does not completely. Obstructed labour is said to result in prolonged labour, when the active phase of labour is longer than twelve hours. Unlike the postsurgical vesicovaginal fistula, however, which is usually the result of focal trauma to otherwise healthy tissues, the obstetric fistula is the result of a field injury to a broad area. Uterine rupture involving the urinary bladder in labor and delivery is a. The field injury that is produced by prolonged obstructed labor may result in multiple birthrelated. Jul 19, 2012 obstructed labour means that, in spite of strong contractions of the uterus, the fetus cannot descend through the pelvis because there is an insurmountable barrier preventing its descent. The clinical effects and public health significance of cpd are discussed, especially in. Ppt obstructed labour powerpoint presentation free to. Describe appropriate management of normal and abnormal labour patterns.
Managing prolonged and obstructed labour asma ali, bonventure ameyo masakhwe kenyauniversity of parma, italy ali a, masakhwe ba. Many of the common causes of maternal and perinatal mortality, including obstructed labour, eclampsia and postpartum haemorrhage, are of an unpredictable nature. Sep 20, 2009 management of labor and obstructed labor. Obstructed labour ranked 41st in gbd 1990, representing 0. Obstructed labour is still a major cause of maternal and perinatal. Two cases are presented, and the differences in diagnosing and managing prolonged and obstructed labor using the partograph findings are reinforced in this module.
The newborn baby can suffer convulsions, sepsis, injury, asphyxia lifethreatening lack of oxygen and death because of obstructed labour. Management of labour learning objectives by the end of this section, the participant will. Without cesarean delivery, obstructed labor can result in maternal and fetal. Effect of preoperative bicarbonate infusion on maternal. Request pdf obstructed labour obstructed labour is an important cause of maternal deaths in communities in which undernutrition in childhood is common. Many cases of obstructed labor and obstetric fistula are not reported because women do not seek. The modules aim to help midwives and others develop into skilled practitioners who are able to think critically and make clinical decisions on. The number of maternal deaths as a result of obstructed labour andor rupture of the uterus varies between 4% and 70% of all maternal deaths, amounting to a maternal mortality rate as high as 410100,000 live births 5. The management of any obstruction is by careful management of labour to initially diagnose the problem and then to manage maternal exhaustion, dehydration, ketosis as well as any infection before delivery which may be vaginal or caesarean section.
Regarding systemic complications grand multiparas are at high risk of developing hypertension, diabetes, anemia and obesity. The partograph for the prevention of obstructed labor. Evolution of the human pelvis and obstructed labor. Delivery mode for prolonged, obstructed labour resulting. Obstructed labour is one of the most common preventable causes of maternal and perinatal morbidity and mortality in developing countries. Pdf global burden of obstructed labour in the year 2000. A criterion based audit of the management of obstructed.
The black curve represents the pdf of d, that is, the distribution of pregnancies. I declare that the prevalence of obstructed labour among pregnant women at a selected hospital, west wollega, ethiopia is my own work and that all the sources that i have used or quoted have been indicated and acknowledged by mean of complete references. Obstructed labour remains a major cause of maternal morbidity and mortality whose complications can be reduced with. Introduction definition of labour obstructed labour causes of obstructed labour clinical presentation complications management prevention introduction obstructed labour is one of the most common preventable causes of maternal and perinatal morbidity and mortality in developing countries. Improving the quality of obstetric care for women with obstructed. Labour dystocia or obstructed labour is associated with significant maternal. On the basis of this, the module explains what makes obstructed labour more likely to occur, what happens in obstructed labour, how signs of obstructed labour can be identified, and. May 19, 2016 if uterine activity is uncoordinated or contractions short or infrequent then labour will be difficult and prolonged. However, this is one complication of pregnancy and labour that can be totally prevented by adequate social health measures. This study was conducted to assess the incidence, causes and outcome of obstructed labor in jimma university specialized hospital. Causes of prolonged andor obstructed labour include. Obstructed labour is a totally preventable labour complication. Apr 03, 2017 a possible cause of obstructed labour is if the mother has a tumor growth or swelling of soft tissue in her pelvic cavity.
This is the first primigravida with combine uterine and urinary bladder rupture. Prolonged and obstructed labor one of the five major causes of maternal death responsible for 8% of all maternal deaths prolonged and obstructed labor is the most common reason for obstetric fistula an estimated 6. It occurs when prolonged obstructed labour without medical intervention causes a hole between the. Moderatesized vesicovaginal fistula from obstructed labour. Obstructed labour injury complex is a term for a broad range of injuries that the. It is highly prevalent in the rural areas of ethiopia, particularly among women who are in labour at home for a long time. Obstructed labour is a labour in which progress is arrested by mechanical factors.
It is important to understand the full impact of the damage to the physical and mental wellbeing of the patient. The second stage is the period of time between full cervical dilatation and birth of the baby, during which the woman has an involuntary urge to bear down, as a result of expulsive uterine contractions. Fetal morbidity and mortality in mothers presenting with obstructed labour compared to other parturients undergoing emergency caesarian section at pgh kakamega. The delivery of a healthy baby and maintenance of a safe delivery for the mother are two goals of all maternity health. Describe and distinguish the management of normal and abnormal progress of labour. Obstructed labor matthews mathai, md, mobstet, phd department of making pregnancy safer, world health organization, geneva, switzerland abstract. International day to end obstetric fistula 2017 to a woman during childbirth. Africa has the highest maternal mortality in the world, estimated at an average of about 1,000 deaths per 100,000 live births.
In order to assess progress in labor, we need to be confident in our definition of active labor and abnormal progress. This study was conducted to identify the risk factors for ol in. If you continue browsing the site, you agree to the use of cookies on this website. Obstructed labor definition of obstructed labor by the. Obstructed labour is a clinical condition where in spite of good uterine contractions, the progr essive descent of the presenting part is arrested due to mechanical obstruction. Aug 18, 2016 obstructed labour pal slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Obstructed labor is one of the common preventable causes of maternal and perinatal morbidity and mortality in developing countries. Obstructed labour british medical bulletin oxford academic. Most people find it difficult to simply remember all of the relevant information. Labor may start out well but stop or stall later if the uterus fails to. Complications of obstructed labour for the surviving infants are birth asphyxia and infections. Patwardhan technique obstructed labour, caesareans section. Incidence 1 2 of referral cases in developing country.
Keeping to the midline, cut down through the cartilage joining the two pubic bones until the. Obstructed labour is when the presenting part of the fetus cannot progress into the birth canal, despite strong uterine contractions. Delivery of the fetus at caesarean section is always difficult, especially if the fetal head is impacted in the pelvis. Obstructed labour definition obstructed labour is one where in spite of good uterine contractions,the progressive descent of presenting part is arrested due to mechanical obstruction. A video demonstration of vacuum extraction from the who reproductive health library is included. Obstructed labor is one of the common causes of maternal, perinatal morbidity and mortality in low income countries 2 3 4. The majority of the patients 59% were primigravidae. The modules can also be used for updating the knowledge and skills of midwifery teachers. Obstructed labor is one of the biggest causes of maternal death and its prevention is. Obstructed labour contributes significantly to the morbidity and mortality among both mothers and babies in ethiopia nationwide, and also in the westwollega region where this study was conducted. Bimbola kemi odu faculty of education, ekiti state university adoekiti, nigeria abstract this paper examined obstructed labour as a major aetiological factor causing vesicovaginal fistula among women. The pathway of obstructed labour as perceived by communities in. Introduction obstructed labour ol is an important clinical and public health problem because of the associated maternal and perinatal morbidity and mortality.
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