The 3 rd batch of Mansoura Manchester programme..

The 3 rd batch of Mansoura Manchester programme..

The 2 nd batch of Mansoura Manchester programme...

The 2 nd batch of Mansoura Manchester programme...

Tuesday, January 8, 2008

Obstructed Labour

Definition: It is arrest of vaginal delivery of the foetus due to mechanical obstruction. Aetiology: (I) Maternal causes: 1-Bony obstruction : e.g. - Contracted pelvis. - Tumours of pelvic bones. 2-Soft tissue obstruction: i) Uterus: - Impacted subserous pedunculated fibroid. - Constriction ring opposite the neck of the foetus. ii) Cervix: cervical dystocia. iii) Vagina: - Septa. - Stenosis. - Tumours. iv) Ovaries : Impacted ovarian tumours. (II) Foetal causes: 1- Malpresentations and malpositions : e.g. - Persistent occipito- posterior and deep transverse arrest, - Persistent mento-posterior and transverse arrest of the face presentation. - Brow, - Shoulder, - Impacted frank breech. 2- Large sized foetus ( macrosomia). 3- Congenital anomalies : e.g. - Hydrocephalus. - Foetal ascitis. - Foetal tumours. 4- Locked and conjoined twins. Diagnosis: It is the clinical picture of obstructed labour with impending rupture uterus (excessive uterine contraction and retraction). (A) History: of - prolonged labour, - frequent and strong uterine contractions, - rupture membranes. (B) General examination : shows signs of maternal distress as: - exhaustion, - high temperature (³ 38oC), - rapid pulse, - signs of dehydration : dry tongue and cracked lips. (C) Abdominal examination: 1- The uterus : - is hard and tender, - frequent strong uterine contractions with no relaxation in between (tetanic contractions). - rising retraction ring is seen and felt as an oblique groove across the abdomen. 2- The foetus : - foetal parts cannot be felt easily. - FHS are absent or show foetal distress due to interference with the utero-placental blood flow. (D) Vaginal examination: 1- Vulva: is oedematous. 2- Vagina : is dry and hot. 3- Cervix: is fully or partially dilated, oedematous and hanging. 4- The membranes : are ruptured. 5- The presenting part: is high and not engaged or impacted in the pelvis. If it is the head it shows excessive moulding and large caput. 6- The cause of obstruction can be detected. (E) Differential diagnosis: 1- Constriction ring. 2- Full bladder. 3- Fundal myoma. Complications: (I) Maternal : 1- Maternal distress and ketoacidosis. 2- Rupture uterus. 3- Necrotic vesico -vaginal fistula. 4- Infections as chorioamnionitis and puerperal sepsis. 5- Postpartum haemorrhage due to injuries or uterine atony. (II) Foetal: 1- Asphyxia. 2- Intracranial haemorrhage from excessive moulding. 3- Birth injuries. 4- Infections. Management: (A) Preventive measures: Careful observation , proper assessment, early detection and management of the causes of obstruction. (B) Curative measures: Caesarean section is the safest method even if the baby is dead as labour must be immediately terminated and any manipulations may lead to rupture uterus.

9 comments:

  1. hi doc! your blog is very informative especially to us students in the medical field.. goodluck! ^_~

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  2. I have uterus-anteverted.enlarged in size.shape and echopattern normal.Right fundic shows intramural fibroid of 29 mm. Endometrium shows thickening upto 14 mm.

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  3. What is the likelihood of a recurrence of an obstructed labour in 2nd or 3rd pregnancies? I was in the latent phase for 3 days and established labour for 22 hours, needing syntocin to stimulate effective contractions. An instrumental delivery was eventually required. Thankfully this was successful as I would have needed a caesarean section. My baby was term + 14, OP and 4.22kg at birth, I am assuming this was the reason for labour being obstructed? I am curious as we are thinking about trying to get pregnant again and I am afraid of histpry repeating itself!

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  4. No doubt, its really a great and informative blog...thank you

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  5. Yes, this is great ..
    Now in this modern world nothing is impossible ..
    Tubal Ligation Reversal is very safe now ..
    but remember the legacy of this operation depends on the doctor moves.so make sure that the doctor has experience in this field.

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  6. You have just given us an information many should know. I'm sure many woman do not know what is an obstructed labor, through this information that you have shared it could be a lot of help. This will help women know early if they have a possible obstructive labor. In case you have fertility concerns, I found this site that maybe helpful.http://www.natural-fertility-prescription.com

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  7. thank you doctor to post this type of things which is very use full to us

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  8. No matter how many blogs, which are able to stand out, attract the line of sight of people, the article content is very wonderful, continue to come on to write this article.

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  9. Excellent post, I like the you have shared the information regarding complications during pregnancy and labor.

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