Obstructed labour

1. INTRODUCTION

Obstructed labour is a serious obstetric emergency where the fetus cannot progress through the birth canal despite strong uterine contractions.

If not managed promptly, it can lead to severe maternal and fetal complications.

2. DEFINITION

Failure of descent of the fetus due to mechanical obstruction, despite good uterine contractions.

3. CAUSES

1. Passage (Pelvic Causes)

• Contracted pelvis

• Pelvic deformities

2. Passenger (Fetal Causes)

• Large baby (macrosomia)

• Malpresentation (breech, transverse lie)

• Malposition (occiput posterior)

• Fetal anomalies (e.g., hydrocephalus)

3. Soft Tissue Causes

• Cervical stenosis

• Tumors (fibroids, ovarian cysts)

• Full bladder

4. RISK FACTORS

• Short maternal stature

• Malnutrition

• Early pregnancy (teenage mothers)

• Previous obstructed labour

• Lack of antenatal care

• Multiple pregnancy

5. CLINICAL MANIFESTATIONS

• Strong, frequent contractions but no progress

• Failure of fetal descent

• Severe abdominal pain

• Maternal exhaustion

• Dehydration

• Distended bladder

• Fetal distress

  
  

6. COMPLICATIONS

Maternal Complications

• Uterine rupture

• Postpartum haemorrhage (PPH)

• Infection/sepsis

• Fistula formation (vesicovaginal fistula)

• Shock and death (if untreated)

Fetal Complications

• Fetal distress

• Birth asphyxia

• Brain damage

• Fetal death

  
  

7. DIAGNOSIS

• Labour not progressing despite strong contractions

• No descent of presenting part

• Clinical examination + partograph

• Signs of obstruction

  
  

8. MANAGEMENT

A. Initial Management

• Admit immediately

• Assess mother (vitals, hydration)

• Start IV fluids

• Catheterization (empty bladder)

• Monitor fetal heart rate

B. Definitive Management

1. Cesarean Section

• Most common and safest method

2. Instrumental Delivery

• Forceps/vacuum (only if safe and indicated)

3. Destructive Operations

• Rare, only in dead fetus (to save mother)

C. Supportive Care

• Antibiotics (prevent infection)

• Blood transfusion if needed

• Treat shock

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9. PREVENTION

• Proper antenatal care

• Early detection of risk factors

• Skilled birth attendance

• Timely referral to hospital

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🚀Here’s a short “exam trick” version for Obstructed labour — super quick points you can remember :

Definition: Failure of fetal descent despite strong contractions.

Cause: Mechanical obstruction (3 Ps – passage, passenger, soft tissue).

Common causes: Contracted pelvis, large baby, malpresentation.

Risk factors: Short stature, malnutrition, teenage pregnancy.

Feature: Strong pains but no progress in labour.

Signs: Maternal exhaustion, dehydration, fetal distress.

Maternal risks: Uterine rupture, PPH, infection, fistula.

Fetal risks: Asphyxia, brain damage, death.

Diagnosis: No descent despite good contractions.

Management: IV fluids + monitor + emergency C-section.

Support: Antibiotics, catheterization, blood transfusion.

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🚀Here’s a set of 07 MCQs on Obstructed labour for practice :

1. Obstructed labour is defined as:

A. Weak contractions

B. Prolonged labour

C. Failure of descent despite strong contractions

D. Early delivery

✅ Answer: C

2. The main cause of obstructed labour is:

A. Infection

B. Mechanical obstruction

C. Hormonal imbalance

D. Hypertension

✅ Answer: B

3. Which of the following is a “Passenger” cause?

A. Narrow pelvis

B. Weak contractions

C. Large baby

D. Cervical stenosis

✅ Answer: C

4. A common risk factor for obstructed labour is:

A. Tall stature

B. Multiparity

C. Short maternal stature

D. Diabetes

✅ Answer: C

5. A serious maternal complication of obstructed labour:

A. Anemia

B. Uterine rupture

C. Hypertension

D. Asthma

✅ Answer: B

6. Fetal complication of obstructed labour:

A. Jaundice

B. Fetal asphyxia

C. Diabetes

D. Anemia

✅ Answer: B

7. Most appropriate management of obstructed labour:

A. Bed rest

B. Antibiotics only

C. Emergency cesarean section

D. Wait and watch

✅ Answer: C