Obstructed Labour

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 Obstructed Labour
• Definition
• It is the arrest of vaginal delivery of the foetus
due to mechanical obstruction.

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 Aetiology
• Maternal causes
a.Bony obstruction: e.g.
> Contracted pelvis.
> Tumours of pelvic bones.
b.Soft tissue obstruction:
>Uterus: impacted subserous pedunculated fibroid,
constriction ring opposite the neck of the foetus.
> Cervix: cervical dystocia.
> Vagina: septa, stenosis, tumours.
>Ovaries: Impacted ovarian tumours.
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 Aetiology
• Foetal causes:
a.Malpresentations and malpositions: e.g.
> Persistent occipito-posterior and deep transverse arrest,
>Persistent mento-posterior and transverse arrest of the face presentation.
>Brow,
> Shoulder,
>Impacted frank breech.
b.Large sized foetus (macrosomia).
c.Congenital anomalies: e.g.
> Hydrocephalus.
> Foetal ascitis.
>Foetal tumours.
d. Locked and conjoined twins.

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 Diagnosis

• It is the clinical picture of obstructed labour

with impending rupture uterus (excessive
uterine contraction and retraction).

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 History
* prolonged labour,
* frequent and strong uterine contractions,
* rupture membranes.

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 General examination
• It shows signs of maternal distress as:
* exhaustion,
* high temperature (³ 38oC),
* rapid pulse,
* signs of dehydration: dry tongue and cracked
lips.

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 Abdominal examination
* The uterus:
> is hard and tender,
>frequent strong uterine contractions with no
relaxation in between (tetanic contractions).
>rising retraction ring is seen and felt as an oblique
groove across the abdomen.
* The foetus:
>foetal parts cannot be felt easily.
>FHS are absent or show foetal distress due to
interference with the utero-placental blood flow.
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 Vaginal examination
* Vulva: is oedematous.
* Vagina: is dry and hot.
* Cervix: is fully or partially dilated, oedematous
and hanging.
* The membranes: are ruptured.
*The presenting part: is high and not engaged or
impacted in the pelvis. If it is the head it shows
excessive moulding and large caput.
* The cause of obstruction can be detected.
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 Differential diagnosis
* Constriction ring.
* Full bladder.
* Fundal myoma.

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 Complications
a.Maternal:
> Maternal distress and ketoacidosis.
> Rupture uterus.
> Necrotic vesico-vaginal fistula.
> Infections as chorioamnionitis and puerperal
sepsis.
> Postpartum haemorrhage due to injuries or
uterine atony.
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 Complications
b. Foetal:
> Asphyxia.
> Intracranial haemorrhage from excessive
moulding.
> Birth injuries.
> Infections

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 Management
Preventive measures:
>Careful observation, proper assessment, early
detection and management of the causes of
obstruction.
Curative measures:
> Caesarean section is the safest method even if
the baby is dead as labour must be immediately
terminated and any manipulations may lead to
rupture uterus.
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