Obstructed labor

Definition
• Obstructed labor is the one where, in spite of good uterine
contractions, the progressive descent of the presenting part
is arrested due to mechanical obstruction.
Incidence
• In the developing countries, the prevalence is about 1–2% in
the referral hospitals.
Etiology

• Fault in the passage:

• (1) Bony: Cephalopelvic disproportion and contracted pelvis are
the common causes.
(2) Soft tissue obstructions: cervical dystocia or broad ligament
fibroid, ovarian tumor .
• Fault in passenger:
• Transverse lie;
• (2) Brow presentation;
• (3) Congenital malformations of the
• fetus—hydrocephalus (commonest),
• fetal ascites,
• double monsters;
• (4) Big baby,
• (5) Compound presentation; (6) Locked twin
Effects on mother
Immediate Remote
Exhaustion Genitourinary fistula or
rectovaginal fistula
Dehydration Secondary amenorrhoea,

Metabolic acidosis due to Vaginal atresia

accumulation of lactic acid and
ketones
Genital sepsis
Injury to the genital tracks include
rupture of the Uterus
Postpartum hemorrhage and shock
Death due to rupture of uterus ,
shock and sepsis with metabolic
changes
 Clinical Features
(1) Patient is in agony from
continuous pain and discomfort and becomes restless;
(2) Features of exhaustion and ketoacidosis are evident;
• (3) Abdominal palpation reveals—
• (a) Upper segment
• is hard and tender,
• (b) Lower segment is distended and tender.
Early sign of Obstructed labour
• Presenting part doesn’t enter the pelvic brim despite of good uterine
contraction.
• Cervical dilation is slow described as a hanging empty sleev.
• Early rupture of membrane
Late sign of Obstructed labour
• Pyrexia, tachycardia
• Urinary output is poor plus or minus hematuria
• Fetal distress
• Bandl‘s ring present
• Vagina is hot and dry
• Presenting part is high and immovable
• Excessive moulding
• Large caput
Diagnosis
• History taking
• Physical examination --mother may present
• 1. Exausted / anxious
• 2. Painful state
• 3. Tachycardia
• 4. Increased, decreased or normal blood pressure
• 5. Dehydration
• 6. Foul smelling breath
• 7. Urine containing ketone bodies or blood
Diagnosis cont...
• Abdomen examination
• By inspection– tonically contructed uterus
• Full bladder
• Bandl’s ring
• By palpation – uterus is tender
• Liquor all drained
• Fetal part difficult to palpate
• By auscultation– fetal heart sound absent
Vaginal examination
• Valval oedema
• Dry hot vaginal mucosa
• Cervix loosely hanging/ partially dilated
• Meconium draining
• Caput on presenting part
• Moulding
Treatment
• Preliminaries:
• Correction of dehydration and ketoacidosis
• Antibiotics- Ceftriaxone 1gm IV is administered
• Metronidazole is given for anaerobic infection.
• Obstetrics:
• Vaginal delivery- forcep delivery
Obsteric managment cont...

• Cesarian section

• Symphysiotomy
Nursing diagnosis.
• 1. Acute pain related to tissue trauma, muscle contraction as evidence
by restless and tachycardia.
2. Risk for injury related to prolonged labour and instrumental delivery.
3. Risk for infection related to repetitive vaginal examination, rupture
membrane
• 4. Ineffective coping related to anxiety and stress as evidence by pale
face, increased tension
• 5. Knowledge deficit related to Obstructed labour as evidence by pale
face and frequent questioning.
Prevention
• Primary prevention: Accessible health system, detection of the
factors likely to produce prolonged labour ( big baby, small women,
malpresentation and position)
• Prevent malnutrition
• Poverty eradication
• Secondary prevention:
• Proper antenatal counseling
• Assesment of risk, e. g - pelvic assessment done to all primigravidas
at 36 weeks
Prevention cont...
• Tertiary prevention:
• Proper monitoring of labour progress, condition of the mother and
fetus by using partograph.
• Definition
• Etiology and risk factors
• Effects on mother and fetus
• Sign of Obstructed labour
• Diagnosis
• Treatment
• Nursing diagnosis
• Complication
• Prevention