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Obstructed labor

Prepared by:

Dr. Gehanath Baral


MBBS,DGO,MD
Senior Consultant Gynecologist & Obstetrician: Government of Nepal
Visiting Professor: CTGU
2nd April, 2007

1
Definition

1. No mechanism of labor in laboring patient.

2. Arrest of descent of presenting part in spite of


good uterine contraction.

2
Cause:

Maternal: Fetal:
1. Malpresentation:
1. Contracted pelvis and 1. Transverse lie
CPD 2. Brow presentation
3. Compound
2. Soft tissue mass or presentation
Lower tract scarring 2. Hydrocephalous
3. Conjoined or Locked
twin

3
Retraction ring formation
Increased contraction
Decreased relaxation

Tonic contraction
+
Continued retraction

Thin distended lower segment

Circular groove encircles uterus


(between upper & lower segment)

Retraction ring
(Bandl’s ring)

4
Retraction ring formation

Primigravida Multigravida

Retraction continues

Further retraction stops


Lower segment distended
further
Uterine inertia
Bandl’s ring rises up towards
umbilicus

Lower segment ruptures

5
Clinical features
S/S: P/A:
• Upper segment  hard/tender
• Agonising pain
• Exhaution • Lower segment  distended/tender
• Dehydration
• Ketoacidosis • Oblique ring between umbilicus &
symphysis
P/V:
• Taut tender round ligament
• Vagina  dry, hot,
offensive discharge • Fetal part ?/FHS?
• Cx dilated
• No membrane

6
Complication
Maternal: Fetal:

• Ruptured uterus/Shock
1. Asphyxia
• Metabolic acidosis
(lactate/ketone)
• Genital sepsis/Septicemia 2. Acidosis
• PPH
• Genito-urinary fistula/RVF 3. Intracranial bleeding
• Sheehan’s syndrome
• Fetal/Maternal death
4. Perinatal death

7
Management
• Treat sepsis: Broad
• Correction of:- spectrum antibiotics
1. Dehydration 1. Gm+ve  Ampicillin
2. Ketoacidosis 2. Gm-ve  Gentamicine /
3. Hemorrhagic shock: Ceftriaxone
– Blood grouping 3. Anerobe  Metronidazole
– x-matching • Release obstruction
– Transfusion • Cesarean section/
Laparotomy