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  • Obstructed Labor: Asheber Gaym M.D. January 2009

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    Israel Wosene
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    This document discusses obstructed labor, including its definition, etiology, diagnosis, complications, and management. Obstructed labor is defined as failure of fetal descent through the birth canal due to mechanical reasons despite adequate uterine contractions. It is a major cause of maternal and neonatal mortality and morbidity in low-resource settings with inadequate intrapartum care. Causes include maternal factors like contracted pelvis and fetal factors like macrosomia. Complications include hypovolemic shock, infection, uterine rupture, fistula, and death for both the mother and baby. Diagnosis involves symptoms of prolonged labor and signs of obstruction during vaginal exam. Management focuses on relief of obstruction through measures like episiotomy, destructive delivery, or

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    Obstructed Labor

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    This document discusses obstructed labor, including its definition, etiology, diagnosis, complications, and management. Obstructed labor is defined as failure of fetal descent through the birth canal due to mechanical reasons despite adequate uterine contractions. It is a major cause of maternal and neonatal mortality and morbidity in low-resource settings with inadequate intrapartum care. Causes include maternal factors like contracted pelvis and fetal factors like macrosomia. Complications include hypovolemic shock, infection, uterine rupture, fistula, and death for both the mother and baby. Diagnosis involves symptoms of prolonged labor and signs of obstruction during vaginal exam. Management focuses on relief of obstruction through measures like episiotomy, destructive delivery, or

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
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    7 views10 pages

    Obstructed Labor: Asheber Gaym M.D. January 2009

    Uploaded by

    Israel Wosene
    This document discusses obstructed labor, including its definition, etiology, diagnosis, complications, and management. Obstructed labor is defined as failure of fetal descent through the birth canal due to mechanical reasons despite adequate uterine contractions. It is a major cause of maternal and neonatal mortality and morbidity in low-resource settings with inadequate intrapartum care. Causes include maternal factors like contracted pelvis and fetal factors like macrosomia. Complications include hypovolemic shock, infection, uterine rupture, fistula, and death for both the mother and baby. Diagnosis involves symptoms of prolonged labor and signs of obstruction during vaginal exam. Management focuses on relief of obstruction through measures like episiotomy, destructive delivery, or

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 10

    Obstructed Labor

    Asheber Gaym M.D.


    January 2009
    Outline

    • Define obstructed labor


    • Discuss the etiology of obstructed labor
    • Describe the diagnosis of obstructed labor
    • Outline complications of obstructed labor
    • Discuss uterine rupture
    • Outline steps in the management of
    obstructed labor

    Asheber Gaym, 2009 2


    Definitions – Obstructed labor

    Obstructed labor – a neglected case of labor in


    which there is failure of descent of fetal
    presenting part through the birth canal for
    mechanical reasons in the presence of adequate
    uterine contractions
    Major cause of maternal and perinatal mortality
    and morbidity in low-resource settings with
    inadequate or inaccessible intrapartum care
    Practically disappeared from the lexicon of
    modern obstetric literature
    Asheber Gaym, 2009 3
    Etiology of Obstructed Labor

    • Maternal Causes • Fetal Causes

    • Contracted • Macrosomia
    pelvis/Cephalopelvic • Malpresentations
    disproportion • Malpositions – OP
    • Tumor previa
    • Locked twins; Collisions
    • Vaginal septa
    • Fetal anomalies
    • Tight perineum
    • Shoulder dystocia
    • Uterine congenital
    anomalies
    Asheber Gaym, 2009 4
    Complications of Obstructed Labor

     Maternal  Fetus/Neonate

     Hypovolemia/Shock  Asphyxia
     Infection/Sepsis  Infection/Sepsis
     Uterine rupture  Trauma
     Obstetric fistula  Death
     Genital trauma
     Neurologic injury
     Death
     Psychological injury
     Postpartum hemorrhage

    Asheber Gaym, 2009 5


    Etiology of Contracted Pelvis/Cephalopelvic
    Disproportion
    • Discrepancy between fetal and pelvic size

    • Genetics
    • Childhood malnutrition
    • Early childhood marriage
    • Poliomyelitis/Kyphoscoliosis
    • Congenital pelvic anomalies
    • Pelvic fracture
    Asheber Gaym, 2009 6
    Diagnosis of Obstructed Labor

     Symptoms  Signs

     Prolonged labor  Hypovolemia/Shock


     Unattended labor  Sepsis
     Referred labor  Three tumor or two
     Symptoms of shock tumor abdomen
     Symptoms of infection  Fetal distress/death
     Symptoms of rupture  Signs of uterine rupture

    Asheber Gaym, 2009 7


    Diagnosis of Obstructed labor

     Vaginal exam  Uterine rupture

     Edematous vulva  Cessation of labor


     Offensive liquor  Diffuse abdominal pain
     Mechonium/Blood  Shock/Sepsis
     Fully/nearly full cervix  Abdominal fluid collection
     Edematous cervix  Easily felt fetal parts
     Excessive caput  IUFD
     Excessive molding  Vaginal bleeding
     High station  Obstructed labor/receding
    fetal part

    Asheber Gaym, 2009 8


    Obstructed labor versus Parity

     Primigravid labor  Multiparous labor

     Uterine inertia following  Increased uterine


    obstruction contractions
     Labor can continue for  Uterine rupture within
    days hours
     Sepsis and shock are  Death often faster
    causes of death compared to the
     Fistula is a major primigravida
    complications
    Asheber Gaym, 2009 9
    Management of Obstructed Labor

     General  Obstruction relief

     Resuscitation  Episiotomy
     Oxygen  Destructive delivery
     Antibiotics  Symphysiotomy
     Catheterization  Caesarean section
     Pain relief  Laparotomy – Uterine
     NG tube drainage of gastric repair or Hysterectomy
    contents
     Hemogram and blood as
    necessary
    Asheber Gaym, 2009 10

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