July 1, 2011

Introduction Definition Incidence Presentation, lie, position of Fetus and satges of labour Risk Factor Cause Diagnosis & prevention Management & complication

It is failure of descent of fetal presenting part in birth cannal due to mechanical reasons . It usually occurs at the pelvic brim, but ocassionally it may ocur in the cavity or the outlet. The passage can be a cause when it has abnormal shape or size and the passenger can be the cause when large, malpositioned or presenting congenital anomalies.

Of 5980 hospital deliveries in our country during the year 2003 only 195 i.e 3.3% were admitted for obstructed labour . With common cause of obstructed labor being CPD followed by malpresentation. The mean duration of labour was 45hrs .

Together with hemorrhage, infection and hypertensive disorders of pregnancy, Obstructed Labour Is the major cause of maternal and prenatal mortality in developing countries like Ethiopia. Genital Fistula, Stress Incontinence, PID, seconadry ammenorhea and uterine rupture are some of its complications.

y Labour is the period between regular uterine

contraction till expulsion. Terms in Labour y Fetal lie- relation of long axis of fetus to that of the mother. It can be transverse or vertical.y Featl presentation- the portion of the fetal body that

is formost within birth cannal or in close proximity to it. e.g cephalic, breechy Fetal habitus- a characterstick posture fetus assumes

during let month pregnancy

y Fetal position- relation of an arbitrarily choosen

portion of fetal presenting part to rt or lt, anterior or posterior side of maternal birth cannal. Stages of labour y 1st stage- is concerned with cervical dilatation. a) latent phase- the time till dilitation of 3-5 cm b) active phase- dilitation of cervix 5-10 cm in presence of uterine contraction y 2nd stage- begins with completion of dilitation and ends with delivery, 3rd is removal of placenta.

y Engagement. y Descent y Internal rotation y Extension y External rotation y expulsion

y Dystocia- means difficult labor and is characterized

by abnormally slow progress of labor.y Generally, abnormal labor is common whenever there

is disproportion between the presenting part of the fetus and the birth canal.y So the d/c b/n dystocia(abnormal labor) and

obstructed labour is the former is difficulty in labour, while the later is failure to descent due to mechanical reasons.

y malnutrition y previous caesarean or stillbirth, previous y y y y

prolonged Labour young age of mother (under 17 years of age) female genital mutilation Custom of early marriage Previous obstructed labour

y MaternalA. Bony obstruction - constructed pelvis - tumors of pelvic bones B .Soft tissue obstruction - uterus; impacted subserous peduculated fibroid - cervix- cervical dystocia - vagina- septa, stenosis ,tumors - ovaries- impacted ovarian tumors

Any contraction of the pelvic diameters that

diminishes the capacity of the pelvis can create obstructed labour. This can be: Pelvic inlet Mid pelvis Pelvic outlet

Contracted inlet:if AP(conjugate ) diameter: