The obstruction usually occurs at the pelvic brim, but occasionally it may occur in the pelvic cavity or at the outlet of the pelvis. These relatives may not be aware of the morbidities possible from obstructed. About half of the maternal deaths 265,000 occurred in subsaharan africa alone, with a third of them occurring in. Improving the quality of obstetric care for women with. Fistulas may develop between different organs, such as between the esophagus and the windpipe or the bowel and the vagina. Obstructed labour means that, in spite of strong contractions of the uterus, the fetus cannot descend through the pelvis because there is an insurmountable barrier preventing its descent. Obstructed labor definition of obstructed labor by the. The original audit was based on case files of deliveries that included a partograph and a physicians diagnosis of obstructed labour in the case of a single foetus in cephalic presentation. Obstructed labor is when the presenting part of the fetus cannot progress into the birth canal, despite strong uterine contractions. These data should inform evidencebased reproductive healthcare policies and programmes at regional and national levels. Obstructed labour due to naegeles pelvis report of a case by ronald j. Introduction obstructed labour ol is an important clinical and public health problem because of the associated maternal and perinatal morbidity and mortality.
Obstructed labour also carries a high risk of intrapartum. On the basis of this, the module explains what makes obstructed labour more likely to occur, what happens in. Who midwifery education module 3 managing prolonged and. The most frequent cause of obstructed labour is cephalopelvic disproportion, a mismatch between the fetal head and the mothers pelvic brim 3 4. Capacitystrengthening efforts to improve the quality of burdenofdisease studies will further validate future estimates. Prevalence and associated factors of obstructed labour, and its. Of the 32,511 women who delivered at mulago hospital, obstructed labour was the main contributor to. Objective of the study was to find out the proportion of obstructed labour cases and their fetomaternal outcome during last 3 years at tertiary level institute. Obstructed labour contributes significantly to the morbidity and mortality. Risk factors for prolonged obstructed labour include short stature, lack of obstetric care, poor nutrition, diabetes and fetal macrosomia, prolonged obstructed labour remains a major reproductive health concern in many developing countries where there is urgent need for improved nutrition, education, health systems and the. On the basis of this, the module explains what makes obstructed labour more likely to occur, what happens in obstructed labour, how signs of obstructed labour can be. Normal labour definitions labour series of events that take place in the genital organs in an effort to expel the viable products of conception out of the womb through the vagina into the outer world. Obstructed labour is a major cause of the deaths maternal mortality and disabilities maternal morbidity mentioned above.
Obstructed labour is a totally preventable labour complication. It is one of the common preventable causes of maternal and perinatal morbidity and mortality in developing and low income countries including ethiopia 2. One of your major roles as a skilled birth attendant is to prevent the occurrence of obstructed labour in women in your community. A fistula is an abnormal connection between two parts inside of the body. Obstruction usually occurs at the pelvic brim, but occasionally it may. Moderatesized vesicovaginal fistula from obstructed labour. Obstructed labour affects 3% to 6% of labouring women globally 5, and in lowresource settings is closely associated with severe maternal morbidity such as postpartum haemorrhage 6,7, uterine rupture 8,9, puerperal sepsis 10, genital fistula 9,11,12 and maternal death,14. Lack of safe, affordable, medically indicated caesarean delivery is a primary contributor to global health inequity. The rate of obstructed labour ranges from 10 per cent to 22 per cent14.
Management of labour and obstructed labour chapter 4 page 3 a vaginal examination should be carried out in 3 hours, then in 2 more hours and every 2 hours thereafter. Exclusion criteria were premature membrane rupture andor severe medical conditions such as eclampsia, cardiac disease, and severe anaemia haemoglobin. Second stage of labour recognition of normal progress and management of delay contd assess for the following prior to consideration of syntocinon, in consultation with obstetric registrar and consultant. Risk factors for ol and its associated obstetric squeal are usually context specific. Since fistulas form as a result of obstructed labour when emergency csections are not available, the logical conclusion is that fistula is a common occurrence.
In obstructed labour the membranes may rupture several hours before labour starts. Obstructed labour is an important cause of maternal deaths in communities in which undernutrition in childhood is common resulting in small pelves in women, and in which there is no easy access to. It is the clinical picture of obstructed labour with impending rupture uterus excessive uterine contraction and retraction. I declare that the prevalence of obstructed labour among pregnant women at a selected hospital, west wollega, ethiopia is my. Pdf on jan 1, 2015, syed rizvi and others published maternofetal outcome in obstructed labour in a tertiary care hospital find, read and. Maternal mortality from obstructed labor is caused by. A possible cause of obstructed labour is if the mother has a tumor growth or swelling of soft tissue in her pelvic cavity. Instructions for how cme credits can be earned appear on the last page of the table of contents. Risk factors for obstructed labour in eastern uganda. Obstructed labour ol is an important clinical and public health problem. If obstructed labour is not diagnosed in time or when it is not properly managed, it can lead to the death or disability of the mother or fetus. Physical or mental exertion, especially when difficult or exhausting.
The pressure deprives blood flow to the tissue, leading to necrosis. Obstructed labour definition of obstructed labour by. In a study conducted in six hospitals in the southwestern part of uganda 2, the prevalence of obstructed labour was 10. Pdf obstructed labor is one of the common preventable causes of maternal and perinatal morbidity and mortality in developing countries. Definition obstructed labour is the failure of the fetus to descend through the birth canal, because there is an impossible barrier preventing its descent. Obstructed labor is one of the biggest causes of maternal death and its prevention is.
Bimbola kemi odu faculty of education, ekiti state university adoekiti, nigeria abstract this paper examined obstructed labour as a major aetiological factor causing vesicovaginal fistula among women. Obstructed labour is the failure of the fetus to descend through the birth canal, because there is an impossible barrier obstruction preventing its descent despite strong uterine contractions. The pathway of obstructed labour as perceived by communities in. Incidence, causes and outcome of obstructed labor in jimma. Module 5 prevention of prolongued and obstructed labor. Prior to obstruction in primigravidae the rate of cervical dilation in the active 1st. Pdf maternofetal outcome in obstructed labour in a tertiary care. Female genital mutilation fgm is the partial or total removal of the external female genitalia or other injury to the female genital organs for nonmedical reasons.
No epidemiological study has documented the risk factors for ol in eastern uganda. Pw 1 was compeltedin the absence of the duty doctor to call his mother in law when he realized that the deceaseds situation had aggravaled. Open access research prevalence of pregnancyrelated. Strengthening emergency and essential surgical care and. During unassisted, prolonged, obstructed labour, the sustained pressure of the babys head on the mothers pelvic bone damages soft tissues, creating a holeor fistulabetween the vagina and the bladder andor rectum. Pdf incidence, causes and outcome of obstructed labor in. Meeting the sdg challenge to end fistula and preventable. Special emphasis is placed on the use of the partograph in monitoring labour. Second stage of labour recognition of normal progerss. In lowincome and middleincome countries lmics, it perpetuates preventable morbidity and mortality caused by prolonged or obstructed labour figure. This study was conducted to identify the risk factors for ol in. It is for midwives and others who work in maternity care and is based on our experiences in yei, south sudan.
Check the fetal heart rate every halfhour at minimum when oxytocin is being infused. Managing prolonged and obstructed labour asma ali, bonventure ameyo masakhwe kenyauniversity of parma, italy ali a, masakhwe ba. Labour is obstructed when the passage of the fetus is blocked. Labour is considered obstructed when the presenting part of the fetus cannot progress into the birth canal, despite strong uterine contractions 1 2. Further complicating the situation for women in these areas is that fact that mothersinlaw and other important family members are in charge of decisions about where a woman may give birth and what to do if the labour does not proceed as hoped. This article is part of a series of continuing education activities in this journal through which a total of 36 amapra category 1 creditstm can be earned in 2007. Prolonged labour or obstructed labour occurs when the fetus does not progress into the birth canal despite strong uterine contractions. In the case of an obstructed labour, the nurses are required to handle the case as an emergency. The major cause of obstructed labor is cephalopelvic disproportion, which may be due to a small pelvis, a large baby, fetal malpresentation, a tight perineum, or abnormalities or tumors of the uterus, ovary, or vagina. Managing prolonged and obstructed labour geneva foundation for.
All cases of obstructed labor delivered by cesarean section 100%. Magnitude of obstructed labor and associated factors. Haemorrhage and hypertensive disorders are major contributors to maternal deaths in developing countries. Labour is considered obstructed when the presenting part of the fetus cannot progress into the birth canal, despite strong uterine contractions.
1397 839 612 939 703 631 387 815 381 853 699 336 5 192 323 297 804 674 640 731 1177 607 872 1066 215 1075 1077 244