Transcript Obstructed labour - Copy.ppt

Obstructed Labor
&
Prolonged Labur
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Determine the factors affecting normal labor
Early diagnosis of abnormal labor
How to manage abnormal or prolonged labor.
Identify the complications of prolonged labor.
► Adequate
Power (uterine contractions)
► Adequate Passage (maternal pelvis)
► Adequate Passenger (fetal size)
 DEFINITION
LABOUR
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OF PROLONGED
When labor tends to be prolonged for more
than 18 hours both in primigravida and
multigravida women
►Fault in passage
►Fault in passenger
►Fault in power :
▪ Hypotonic Uterine Dysfunction (inertia)
►Can be 2ry to Epidural analgesia or
 Chorio amnionitis
 ▪ Hypertonic / In coordinate Uterine function
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History:
1.Age
2.Parity
3.Duration of labor
4.Duration of membrane rupture
5.Whether the patients was handle outside the
hospital
6.Whether she was treated with oxytocin drugs
7.Previous history of difficult labor, instrumental
delivery
or stillbirth
Abdominal examination:
 1. Contour of the uterus
 2. Presentation & position
 3. Tenderness
 4. Frequency, intensity & duration of uterine
contraction
 5. Lower segment distended
 6. Distension of the bladder
Vaginal examination:
- The vulva usually swollen and edematous.
- The vaginal is dry, hot and occasionally
offensive and purulent discharge
- The cervix is almost fully dilated
- The presenting part is extremely molded
and jammed in the pelvis
- There is usually large caput formation
Management
A. General management :
1. NPO & i/v fluid start immediately
2. Bladder evacuation.
3. Parenteral antibiotics.
4. Intake output chart should be strictly maintain
5. Blood should be send for grouping and cross
matching
Obstetric Management
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During 1st stage:
1. Role of oxytocin : hypotonic uterine contraction
2. Role of sedation : incoordinate uterine contraction use of
narcotics may lead to spontaneous correction
3. Role of amniotomy in correction of hypotonic uterine
contraction
4. Role of cesarean section: contracted pelvis, big baby,
malpresentation, malposition, severe fetal distress
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During 2nd stage:
1. Role of episiotomy: rigid / tight perineum
2. Role of instrumental delivery (Forceps or
Vacuum): in case of fetal distress,
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3. Role of cesarean section: contracted pelvis,
big baby, malpresentation, malposition, and
severe fetal distress
Complications
Fetal:
Immediate:
- Birth trauma
- Birth asphyxia
- Fetal distress
- Meconium aspiration
syndrome
- Stillbirth
- Neonatal death
!
Late:
- Cerebral palsy
- Mental retardation
Maternal:
Immediately:
-Maternal distress
-Maternal injury
-PPH
-Puerperal sepsis
-Maternal death
!
Late:-Urinary fistula
-Vaginal stenosis
-Secondary infertility
 Obstructed
labour
►Definition : defined as labor where there is poor or
no progress of labor in spite of good uterine
contraction!
►Incidence :- 1 -2% of cases in developing country
Causes
►Maternal condition (fault in the passage):
1. Contracted pelvis
2. Abnormal pelvis: android, anthropoid
3. Pelvic tumor: fibroid, ovarian tumor
4. Tumor of rectum, bladder or pelvic bone
5. Abnormality in uterus & vagina: scarring in cervix, vaginal
septum, rigid perineum
 fetal
causes
 Big baby
 Big head, hydrocephalus
 Deflexed head, brow and face
mentoposterior.
 Oblique or transverse lie
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Diagnosis
►Partogram will recognize impending
obstruction of labor
►Careful general, abdominal and vaginal
examination can detect if labor is slow or
no progress
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General examination:
Features of maternal distress
Dehydration
Tachycardia >100/m
Raise temperature
Scanty urine
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Abdominal examination :
-The retraction ring might appear and felt
between the tonic contracted upper
segment of the uterus and the distended
lower segment
- Distended urinary bladder
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Vaginal examination:
- The vulva usually swollen and edematous
- The vaginal can be dry and hot
- The cervix is almost fully dilated or hanging
like a curtain
- The presenting part is extremely molded
and jammed in the pelvis
- There is usually large caput formation
Complication
Maternal:
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-Rupture of uterus
-Urogenital fistula
-Rectovaginal fistula
-Postpartum hemorrhage
-Puerperal sepsis
-Shock
-Maternal death
Fetal:
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-Intra uterine asphyxia
-Intracranial hemorrhage
-Neonatal infection
-Metabolic Acidosis
-Fetal death
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Management
►Preventive:
- Proper assessment of pregnant woman during ANC
- Regular ANC visit
- Proper assessment in early labor to
- Use of Partogram
- Prompt and appropriate treatment
Obstetric Management
1. Delivery of fetus:
a. Vaginal delivery: if head is low and vaginal delivery
is not risky, forceps extraction may be done
b. Caesarean section:
2. Active management of 3rd stage of labor
3. Continuous bladder drainage for 2-3 days to
prevent any urogenital fistula