Topic: Obstructed Labor.
Sub: Midwifery & Obstetrical Nursing
For : (Basic, Post-Basic And Diploma )in Nursing Students
Obstructed labor is one where in spite of good uterine contraction the progressive descent of the presenting part is arrested due to mechanical obstruction. It is a most dangerous condition. It is the untreated can be fatal to both mother and fetus.
Causes of obstructed labor
- Contraction or deformity of the bony pelvis.
- Pelvic tumors
- Uterine fibroids
- Ovarian tumors
- Tumors of rectum bladder or pelvic bones.
- Abnormalities of uterus or vagina
- Stenosis of the cervix or vagina
- Obstructions by one horn of double uterus.
- Contraction ring of uterus.
- Large fetus
- Malposition or malpresentation.
- Persistent occipito – posterior or transverse position
- Mento posterior position
- Brow presentation
- Breech presentation
- Shoulder presentation
- Compound presentation
- Locked twins.
- Prolonged labor often extending to days rather than hours.
- Patient looks tired and anxious.
- The membranes rupture early in labor because the presenting part is badly applied the lower segment.
- Pulse rate and temperature rises.
- Quantity of urine decrease and presence of ketone bodies in the urine.
- Abdominal palpation reveals-
- Upper segment hard, uniformly convex and tender. Lower segment is distended and tender.
- The pathological retraction ring is placed obliquely between the umbilicus and symphysis pubis.
- Fetal parts may not be well defined.
- FHS usually absent.
- On vaginal examination
- Vagina is found edematous and feels dry, the discharge is offensive.
- Cervix fully dilated.
- Membranes are absent.
- USG- Previous USG may provide a clue about the cause of obstructed labor.
- Blood : Hb%, TC, DC
- Blood grouping and Rh typing.
- In a hospital admit the patient straight to the delivery unit or operating theatre.
- Blood group and Rh typing.
- Start intravenous fluid away to correct dehydration.
- Vital sign should be checked regularly.
- Dehydration and ketoacidosis are to be energetically corrected by rapid infusion of 5% dextrose at least one liter is to be given in drip.
- Acidosis is corrected by I.V administration of 100 ml 8.4% sodium bicarbonate and to be prepared.
- Antibiotic to prevent infection.
A balanced decision should be taken or the method of delivery and there is no place of wait and see.
- Vaginal delivery
- Epistomy may the only intervention required in a patient with the presenting part in the perineum. This is often the case when obstruction is due to tight perineum.
- An operative vaginal delivery should never be tried if there is uterine rupture as it can cause.
- Instrumental delivery: Ventouse or forceps delivery if-
- No major degree CPD
- Descent not more than 1/5 above brim.
- Other precondition for forceps and vacuum are met.
- The fetus must be alive.
- If fetus is invariably dead destructive delivery is best choice to relieve obstruction.
Cesarean Section: Cesarean section is indicated if –
1.The fetus is alive and exceptional condition for instrumental delivery are not satisfied.
2.The fetus is dead and conditions for vaginal operative deliveries are not met.
Effects on mother
- Exhaustion is due to a constant agonizing pain and anxiety.
- Dehydration due to increased muscular activities without adequate fluid intake.
- Metabolic acidosis.
- Genital sepsis.
- Postpartum hemorrhage and shock.
- Uterine rupture.
Effects on fetus
- Intra-cranial hemorrhage
Prevention of obstetric labor
- Good obstetric service.
- Screening for risk factors, especially short stature.
- A pelvic assessment at 36 weeks.
- The routine use of the partogram during intranatal period.