Management of obstructed labour:

1) Rehydrate the patient

Aim: To maintain normal plasma volume and prevent or treat
dehydration and ketosis.

(a) Put up an IVI. Use a large needle (No. 18) or cannula.

(b) If the woman is shocked, give normal saline or Ringer’s lactate. Run
in 1 litre as quickly as possible, then repeat 1 litre every 20 minutes
until the pulse slows to less than 90 beats per minute, systolic blood
pressure is 100 mm Hg or higher. However, if breathing problems
develop, reduce to 1 litre in 4–6 hours.

(c) If the woman is not in shock but is dehydrated and ketotic, give 1 litre
rapidly and repeat if still dehydrated and ketotic. Then reduce to 1
litre in 4–6 hours.

(d) Keep an accurate record of all intravenous fluids infused, and urinary
output.

2) Give antibiotics
If there are signs of infection, or the membranes have been ruptured for 18
hours or more, or the period of gestation is 37 weeks or less, give
antibiotics as follows:
 ampicillin 2 g every 6 hours, and
 gentamicin 5 mg/body weight IV every 24 hours.
If the woman is delivered by caesarean section, continue antibiotics
and give metronidazole 500 mg IV every 8 hours until the woman is
fever-free for 48 hours.

3) Give supportive care

A health care worker should accompany the woman on the journey,
together with a relative who could act, if necessary, as a blood donor on
arrival at the hospital.
4) Deliver the baby

The doctor will assess the woman and her progress in labour and decide on
the mode of delivery.

Cephalopelvic disproportion:
  If cephalopelvic disproportion is confirmed, delivery should be by
caesarean section
 If the fetus is dead:

- delivery should be by craniotomy

- if this is not possible, delivery should be by caesarean section.

Obstruction:

 If the fetus is alive, the cervix is fully dilated and the head is at 0
station or below, deliver by vacuum extraction
 If the fetus is alive and the cervix is fully dilated and there is
evidence of indication for symphysiotomy for relatively minor
obstruction (if safe caesarean section is not possible) and the fetal
head is at -2 station, then delivery should be by symphysiotomy
and vacuum extraction.
 If the fetus is alive but the cervix is not fully dilated or if the
fetal head is too high for vacuum extraction, referral should be
made immediately for delivery by caesarean section
 If the fetus is dead:
- delivery should be by craniotomy
- if this is not possible, delivery should be by caesarean section.

If the woman requires referral to a higher level health facility, initial

management will be similar because preparation for the journey is
essential:

a. set up IVI to rehydrate

b. give antibiotics
c. give supportive care
d. give analgesic
e. monitor maternal and fetal condition.
f. ensure referral letter is completed and make transportation
arrangements. Contact the referral centre by phone if possible to
advise them of transfer.

Reference: WHO. 2008. Managing Prolonged and Obstructed Labour.