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Obstructed Labour

- An Avoidable Tragedy

PROF. SURENDRA NATH PANDA, M.S.


&
DR. ANITA LENKA, M.B.B.S. Postgraduate
Dept. of Obstetrics and Gynaecology
M.K.C.G. Medical College Hospital

Berhampur, Orissa, INDIA


INTRODUCTION
Even in the 21st century, obstructed labour still remains a life-
threatening catastrophe all over the world mostly in the
developing countries. This entirely preventable labour
complication carrying a very high maternal and neonatal
morbidity and mortality is an indicator of the inadequacy and
poor quality of obstetric care.
Our hospital being a tertiary hospital, receives labour
patients in very late stage in very bad condition from whole of
south and southwest Orissa, one of the poorest regions of the
country. So, an attempt has been made to investigate this
unfortunate but almost entirely preventable complication of
labour.
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MATERIAL & METHODS

From October 1999 to December 2001,


256 cases of Obstructed Labour admitted in
the Obstetrics and Gynaecology department
of M.K.C.G Medical College Hospital,
Berhampur, Orissa, were studied and the
results of the analysis are presented here.

July 13, 2009 Obstructed Labour-An avoidable Tragedy--Prof.S.N.Panda & Dr Anita Lenka 3
MAGNITUDE OF OBSTRUCTED LABOUR IN
OUR HOSPITAL
EVENTS TOTAL OBSTRUCTED LABOUR
During 10/99 –12/01 NO. NO (%)
DELIVERIES 4107 256 (06.23)
CAESAREAN SECTION 1595 213 (13.35)
INSTRU. DELIV. 131 NIL NIL
RUPTURE UTERUS 37 26 (70.27)
OBST. HYSTERECTOMY 34 22 (64.71)
DESTRUCTIVE OPERATION 17 17 (100.00)
MATERNAL DEATH 98 04 (04.08)
LIVE BIRTH 3778 190 (05.03)
STILL BIRTH 340 67 (19.71)
NEONATAL DEATH 324 24 (07.41)

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AGE AND PARITY OF PATIENTS
Parity > 0 1 2 3 4+ Total
Age in Yrs. No. ( %)
<20 59 08 00 00 00 67 (26.17)
21-25 68 30 05 05 04 112 (43.75)
26-30 20 17 06 13 07 63 (24.61)

31-35 03 01 00 00 06 10 (03.91)
>35 00 00 02 00 02 04 (01.56)

Total 150 56 13 18 19 256 (100)


(%) (58.59) (21.88) (5.08) (7.03) (7.42)

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DEMOGRAPHIC PROFILE
CHARACTERISTICS NO ( %)
RESIDENCE
Rural 220 (85.94)
Urban 36 (14.06)
LITERACY
Illiterate 220 (87.94)
Literate 31 (12.11)
SOCIO-ECONOMIC STATUS
Lower 226 (88.28)
Middle 30 (11.72)
A.N.C
Unbooked 234 (91.41)
Booked 22 (08.56)
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MATERNAL CONDITION AT ADMISSION
Condition At Admission Number (%)

A-Minimal Obstruction, maternal 67 26.17


condition Good

B-Moderate Obstruction, 32 12.50


maternal condition Good

C-Mod / Severe Obstruction, 139 54.30


maternal condition Bad

D-Rupture Uterus 18 07.03

Total 256 100

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DURATION OF LABOUR AND RUPTURE
OF MEMBRANE AT ADMISSION
Dur. in Hrs Labour Rupt.of Memb.
NO. (%) NO. (%)
12 or less 37 (14.45) 124 (59.05)
13-18 69 (26.96) 53 (25.23)
19-24 70 (27.34) 26 (8.09)
25 or more 80 (31.25) 53 (7.62)
Total 256 256

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CAUSES OF OBSTRUCTED LABOUR
Cause No. (%) Cause No, (%)

CPD 140 (54.69) TWIN 2 (0.95)


Locked ------1
Conjoined---1
DTA 45 (17.58) BROW 1 (0.47)
TRANS. LIE 33 (12.89) HYDROCEP. 1 (0.47)
OCC.POST. 17 (6.64) COMP.PRES. 1 (0.47)
NON DILA. OF CX. 9 (3.52) FOE. ASCITES 1 (0.47)
BREECH 3 (1.17) CX. FIBROID 1 (0.47)
FACE 2 (0.78)
(Mento-Posterior) TOTAL 256

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MODE OF DELIVERY
CAESAREAN SECTION 213* 83.20%
 Live Births 190+
 Still Births 24+
 Neonatal Death 24
DESTRUCTIVE OPERATIONS 17 06.64%
 Craniotomy 06
 Evisceration 08
RUPTURED UTERUS 26 10.16%
 Hysterectomy 22
 Repair 04
TOTAL 256
*One patient underwent hysterectomy on 9th day for infection & gangrene
+Includes one twin delivery of live & still birth

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MATERNAL MORBIDITY AND MORTALITY
MORBIDITY No. (%) MORBIDITY No. (%)
Pyrexia 128 (50.00) Broad Ligament 12 (4.69)
Haematoma
P.P.H 85 (33.20) Pritonitis 6 (2.34)

Blood trans. 65 (25.39) Shock 5 (1.95)


Wound Inf. 45 (7.14) Paralytic ileus 3 (1.42)

U.T.I 25 (9.52) Pneumonia 3 (1.42)


Sub involution 24 (9.77) V.V.F. 2 (0.78
Thrombophleb. 14 (5.71) Burst abdomen 1 (1.42)
No.Of Morbid Pts. 1 (88.28) DEATHS 4 (1.42 )

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NEONATAL MORBIDITY AND
MORTALITY IN 161 LIVE BIRTHS
MORBIDITY No. (%) DEATH
Birth Asphyxia 74 (38.95) 13
Septicemia 31 (19.25) 6
Meconium Aspiration Syndrome 28 (4.74) 3
Convulsion 10 (5.26) 2
Jaundice 59 (36.64) 0
Umbilical Sepsis 12 (6.32) 0
Diarrhoea 4 (2.48) 0
Facial Injury 3 (1.580
Cephlohaematoma 2 (1.05)
NEONATES WITH MORBIDITY 156 (82.11) 24

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CONCLUSION
These tragic case histories bear testimony to the fact that
obstructed labour is the result of multi level deficiencies in
our health care delivery system.
Once this complication arise, swift access to high quality
professional treatment is essential, if lives are to be saved.
However more importantly it is essential that all efforts
should be made to prevent the occurrence of the
complications in the first place.
For this we have to improve the socio-economic
environment of the women.
There is need for information on existing facilities,
utilization of facilities, changing demands and accessibility
and availability of efficacious and safe obstetric care

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CONCLUSION
 To decrease this unfortunate & mostly preventable
obstetric complication, restructuring of M.C.H. Services
should be done with particular attention to: -
 Increasing community awareness
 Promotion of appropriate technology and
 Effective health care planning starting from grassroots
levels to tertiary levels
 Establishment of an streamlined and effective referral
system

July 13, 2009 Obstructed Labour-An avoidable Tragedy--Prof.S.N.Panda & Dr Anita Lenka 14
LET US MAKE MOTHERHOOD SAFE

This Paper was presented at the 45th All India Obstetric and Gynaecological
Congress at Bhubaneswar on 07-01-2002

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