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Obstructed Labour

Obstructed labour occurs when there is no advancement of the fetus during contractions due to an obstruction in the birth canal. The obstruction is usually at the pelvic brim but can also occur at the outlet. Obstructed labour is caused by problems with the fetus (cephalopelvic disproportion, malpresentation, abnormalities) or the birth canal, whereas prolonged labour is usually due to weak contractions. Early signs of obstruction include slow cervical dilation and rupture of membranes. Later signs include distress, hypertonic contractions, and molding of the uterus around the fetus.

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492 views

Obstructed Labour

Obstructed labour occurs when there is no advancement of the fetus during contractions due to an obstruction in the birth canal. The obstruction is usually at the pelvic brim but can also occur at the outlet. Obstructed labour is caused by problems with the fetus (cephalopelvic disproportion, malpresentation, abnormalities) or the birth canal, whereas prolonged labour is usually due to weak contractions. Early signs of obstruction include slow cervical dilation and rupture of membranes. Later signs include distress, hypertonic contractions, and molding of the uterus around the fetus.

Uploaded by

georgeloto12
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Obstructed Labour

Labour is obstructed when there is no advance of the presenting part in spite of strong uterine contractions
further progress is impossible without assistance. Usually the power (contractions) involves the passage
(the birth canal) and the passenger (the foetus). Obstruction usually occurs at the pelvic brim, but may
occur at the outlet, for example, in an android pelvis.
Compare the causes of obstructed labour with those of prolonged labour. In obstructed labour, the problem
is the passenger and passage (never the power). Usually this is when the passenger has gross
abnormalities. This is the opposite of prolonged labour where the 'power' may be the main issue and the
passenger or passage have mild or moderate problem.

The Main Causes of Obstructed Labour


 Cephalopelvic disproportion
 Malpresentation, for example; shoulder, brow presentation or persistent mentoposterior position
 Fibroids or tumours located in the lower uterine segment
 Cervical dystocia (cervix fails to dilate)
 Gross foetal abnormalities e.g. hydrocephalus, locked twins
 Disordered uterine action

Diagnosis of Obstruction of Labour


Early Signs
 The presenting part does not enter the pelvic brim despite good uterine contraction
 The cervix dilates slowly and hangs loosely like an empty
sleeve due to poor application of the presenting part
 The membranes tend to rupture early

Later Signs
 Foetal and maternal distress, which occur concurrently
 The contractions are hypertonic and the mother does not relax in between them
 The uterus is moulded around the foetus
 The mother may have pyrexia and tachycardia
 On vaginal examination, there is presence of large caput
 The vagina feels hot and dry and the cervix and vulva are oedematous
 In cephalic presentation, the presenting part becomes wedged and immovable when it descends
partly into the pelvis
 It is difficult to pass urine, if catheterised, the urine is bloodstained due to the bruised urethra
 Urinary output is poor
 Uterine exhaustion occurs and contractions cease for a while, only to recommence with renewed
vigour, especially in primigravida
 A Bandle’s ring is seen abdominally as the lower segment is progressively enlarged and thinned
out and the upper segment becomes shorter and thick

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