OBSTRUCTED LABOUR

Failure of labour to progress despite good uterine contractions.

Causes

  • Cephalopelvic disproportion (CPD)
  • Large baby
  • Foetal abnormalities: hydrocephalus, conjoined twins
  • Small or deformed pelvis
  • Malpresentation: the presenting part of the foetus is not the head, e.g. breech presentation, shoulder presentation, face, etc
  • Malposition: an abnormal position of the foetal head when this is the presenting part, e.g. occipito-posterior
  • Any barrier that prevents the baby’s descent down the birth canal

Clinical features

  • Contractions are strong but no evidence of descent of the presenting part
  • Malposition or malpresentation may be felt on abdominal examination
  • In a first delivery, the pains will just stop spontaneously
  • Foetal distress with meconium stained liqour
  • Fever and dehydration with maternal exhaustion
  • In late stages, the regular colicky strong pains may stop when the uterus is ruptured, and be replaced by a dull
    continuous pain
  • Signs of shock if the uterus has ruptured
  • Physical examination reveals signs of shock, tender uterus, formation of a Bandl’s ring, vulva may be oedematous, vagina is hot and dry, there’s usually a large caput

MANAGEMENT

  • Set up an IV normal saline line and rehydrate the patient to maintain plasma volume and treat
    dehydration and ketosis
  • Start 5-day course of antibiotics: Amoxicillin 500mg every 8 hours or erythromycin 500 mg every
    6 hours
  • Plus metronidazole 400 mg every 8 hours
  • Refer urgently to Hospital for further management
Note
  • Every woman with prolonged/obstructed labour should receive the management protocol for prevention of
    obstetric fistula

Prevention

  • Careful monitoring of labour using a partogram for early recognition
  • Active management of labour