Obstructed labor

Obstructed labor is a severe medical condition that occurs when the baby does not exit the pelvis during childbirth due to being physically blocked, despite the mother's effort. This condition is a significant cause of not only maternal mortality but also infant mortality and morbidity.

Causes

Obstructed labor can be caused by several factors. The most common cause is a mismatch between the size of the fetus and the mother's pelvis, a condition known as cephalopelvic disproportion (CPD). Other causes can include malpresentation of the fetus, such as breech birth or shoulder presentation, and abnormalities of the birth canal, such as a fibroid or pelvic fracture.

Diagnosis

The diagnosis of obstructed labor is typically made based on the clinical presentation of the mother and fetus. This includes prolonged labor, abnormal fetal heart rate, and failure of the cervix to dilate further. Additional diagnostic tools may include ultrasound to assess the position and size of the fetus and the mother's pelvis.

Treatment

The primary treatment for obstructed labor is cesarean section. In some cases, if the obstruction is identified early, labor may be assisted with the use of forceps or a vacuum extractor. If the obstruction is due to a malpresentation, an attempt may be made to manually turn the fetus to a more favorable position, a procedure known as external cephalic version (ECV).

Complications

If not treated promptly, obstructed labor can lead to serious complications for both the mother and the baby. These can include uterine rupture, postpartum hemorrhage, sepsis, and fistula formation in the mother, and hypoxic-ischemic encephalopathy, neonatal asphyxia, and death in the baby.

Prevention

Prevention of obstructed labor involves antenatal care to identify potential risk factors, such as a small pelvis or large fetus, and to plan for a safe delivery. This may involve scheduling a cesarean section if the risk of obstruction is high.

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