Obstructed labour

Obstructed labour, also known as labor dystocia, is a condition where, despite strong and regular uterine contractions, the baby does not exit the pelvis during childbirth due to being physically blocked. This condition is a significant cause of both maternal and neonatal morbidity and mortality, especially in regions with limited access to healthcare. Understanding the causes, symptoms, management strategies, and potential complications of obstructed labour is crucial for healthcare providers and expectant mothers.

Causes

Obstructed labour can be caused by a variety of factors, often categorized into issues with the "three P's": the power (strength of contractions), the passenger (the baby), and the passage (the pelvis and birth canal).

• Power: Inadequate uterine contractions can fail to move the baby through the birth canal effectively.
• Passenger: Fetal factors such as abnormal presentation (e.g., breech or shoulder dystocia), large fetal size (macrosomia), or congenital anomalies can contribute to obstruction.
• Passage: Anomalies in the maternal pelvis or obstruction in the birth canal, such as a narrow pelvis, pelvic tumors, or scarring from previous surgeries or genital mutilation, can prevent the baby from being born vaginally.

Symptoms

Symptoms of obstructed labour include failure of the cervix to dilate fully despite strong contractions, the baby's head failing to descend into the pelvis, excessive maternal exhaustion, and signs of fetal distress. If left unmanaged, obstructed labour can lead to severe complications for both the mother and the baby.

Management

The management of obstructed labour requires timely intervention to prevent complications. Options include:

• Cesarean Section: Surgical delivery of the baby is often necessary if obstructed labour cannot be resolved through other means.
• Instrumental Delivery: In some cases, the use of instruments like forceps or a vacuum extractor can assist in delivering the baby.
• Manual Rotation: Manual rotation might be attempted if the obstruction is due to the baby's position.

Preventive strategies include antenatal care to assess the risk of obstructed labour, such as measuring the pelvis and monitoring the baby's growth.

Complications

Complications from obstructed labour can affect both the mother and the baby. Maternal complications include uterine rupture, postpartum hemorrhage, and infections. Neonatal complications can include birth asphyxia, physical injury, and stillbirth. Long-term, women may suffer from obstetric fistulas, leading to incontinence and social isolation.

Prevention

Prevention of obstructed labour involves regular prenatal care, including assessment of maternal pelvis size and fetal position and size. Education on the signs of obstructed labour for expectant mothers and healthcare providers is also crucial.

Conclusion

Obstructed labour is a critical condition requiring prompt recognition and management to prevent severe complications. Through comprehensive prenatal care and appropriate intervention strategies, the risks associated with obstructed labour can be significantly reduced.