90 Obstructed Labour

Ed McLaren 13/11/18

90.1 Recognition, Managment, Prevention, and Consequences of Obstructed Labour

What is obstructed labour? : When the presenting part of the fetus cannot progress into the birth canal, despite strong uterine contractions

How big a deal is obstructed labour? : 1/5 of Maternal Deaths in Uganda. For every mother who dies in obstructed labour, another 20-30 suffer significant morbidity

What is the 3 Delay Model in Care ? :

What are the consequences of neglected obstructed labour? : Uterine Rupture, Obstetric Fistula, Incontinence, Infection, Encephalopathy, Maternal Death, Foetal Death

What can you do to reduce obstructed labour? : Focus on the 3 delay model. Think of improving health care facilities (and access to partograph). Think of transport infrastructure, waiting roums

What components on the partograph: Fetal HR, Cervical Dilatation, Contractions, Oxytocin, Drugs, Maternal HR Temp and Urine output

What simple tool can you use to reduce the risk of obstructed labour : Use a partograph! Think of it as like a NEWS chart for labour

What should you kind of need in cervical dilatation rate in our: 1cm dilatation / hr

What barriers to partograph use? : Not physically available, Time Constraints of Staff, Labour Started in Community and too late, Knowledge, Leadership and Education and Confidence

Why might there be obstructed labour? : 3 P’s - Power: Uterine Contractions, Passage: Shape of Pelvis, Passenger: Baby

Why might a multiparous woman fail to progress in labour? : It won’t be a power problem in contractions, it more likely will be a foetal

What are the complications found with Obstetric Fistula Complex? : Increased rate of stillbirth (95% rate with fistula), Leaking of urine and faeces, Smell, Dermatitis, Dehydration, Social Isolation, Depression, Suicide

Why do people get obstetric fistula? : Young marriage, Poor access to obstetric care, Poor funding, Women’s status in family or community. Obstructed labour (3 Delays model)

Why does obstructed labour cause obstetric fistula? : Babies head and pubic symphisis push against tissue, causing ischaemia of bladder tissue

How to reduce risk of obstetric fistula? : Reduce risk of become pregnant (contraception, education), High risk screening and antenatal care, Increase capacity for surgical intervention (C-Sections)

Which two groups of patients do you need to worry about for uterine rupture? : Multiparous ( > 5 ), Previous Caesarean Section