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Obstructed labour

Monday, May 1st 2017. | Obstructed labour

During labour sometimes the foetus finds it difficult to descend through the birth canal when there is some obstruction to its natural passage through it. The obstruction causes the labour to become prolonged because of the failure to progress and this is called obstructed labour.

Labour can get obstructed because the power of contractions of the uterus are weak or un-coordinated. The baby cannot be pushed down and the cervix fails to dilate.

If the head of the foetus is too large or if the baby’s position is not correct the labour can get prolonged. So a foetal head that is large in proportion to the pelvis, or a foetus with hydrocephalus, (excess fluid in the brain) may cause obstruction.Breech Presentation

Sometimes babies present with  breech (the baby’s buttocks and/or its feet present first), and shoulder. The baby’s head is down but the vertex may be in the wrong position relative to the mother’s pelvis.

If there is a “locked” twin pregnancy, or if there are conjoined twins (twins fused at the chest, head or any other site) there can again be an obstruction of labour.Conjoined Twins

A contracted or small pelvis, the result of malnutrition, (cephalo-pelvic disproportion or CPD) or a deformed or out of shape pelvis due to trauma or polio can cause obstruction. The maternal pelvis  is either too narrow for the foetal head, or the foetal head is large relative to that mother’s pelvis.

A possible cause of obstructed labour is if the mother has a tumour (growth or swelling of soft tissue) in her pelvic cavity.

In obstructed labour the membranes may rupture several hours before labour starts. The labour goes on for more than 12 hours. The mother looks exhausted, anxious and weak. Her pulse rate is fast, more than 100 per minute. Her respiration is more than 30 breaths per minute. Her blood pressure is low and she has a raised temperature.Obustruction by tumors

A meconium discharge from the vagina may be noted. The vulval tissues could be swollen. The vagina feels hot and dry and the cervix is swollen. The foetal head does not fit into the cervix and may feel swollen. The urine may be concentrated and show the presence of blood or meconium. The abdomen could show 2 or 3 separate masses separated by a depression, known as Bandl’s ring.

If the mother is in shock her blood pressure must be managed by I/V Normal Saline or Ringer’s Lactate till her pulse and BP are normal. A full bladder must be drained by inserting a catheter. Relieving this obstruction can sometimes be enough to allow the baby to be born. The mother may need emergency delivery by caesarean section to get the baby out alive and also to save her life.

The commonest complication from obstructed labour is the formation of a fistula. A fistula is an abnormal opening (usually as a result of ruptured tissues) between the vagina and bladder, ureter, rectum or urethra.

Unless well managed, obstructed labour can also lead to severe haemorrhage after delivery. The return of the uterus to its pre-pregnancy size is slow. The small intestine could become paralysed and stop movement (paralytic ileus) or there could be widespread infection throughout the body or sepsis. It can also cause death due to shock.

The newborn baby can suffer convulsions, sepsis, injury, asphyxia (life threatening lack of oxygen) and death because of obstructed labour.

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