Analysis of Medical and Social Causes of Obstructed Labour

Background: Obstructed labour is one of the major causes of maternal mortality (8%) in Bangladesh. It is also responsible for high rate of maternal and fetal morbidity. If we can identify the medical and social causes of obstructed labour in our country it may be helpful to find out the way to prevent this disease. Objectives: This study was to find out the medical and social causes of obstructed labour in our country. It also finds out the cause of delay in seeking care.Material & Methods:This study is a prospective observational study has been done in Dhaka Medical College Hospital, Dhaka from August 2004 to December 2005. One hundred patients who were admitted with obstructed labour during study period were included in this study.Results:In this study prevalence of obstructed labour was 3.59%. Among the patients who were admitted with obstructed labour 52% were within 20 to 25 years of age, 55% were primigravida, only 30% were on regular antenatal checkup. The medical causes of obstructed labour were cephalopelvic disproportion in 30%, malposition and malpresntation in 69% and cervical fibroid in 1 %. In this study 72% of study population had monthly income below 3,000 BTD, 27% had 3,001 � 5,000 BDT and only 1 % had above 5,000 BDT. Among them 8% patient had crossed the primary level of education and 35% were illiterate. The patients who were admitted with obstructed labour could not utilize the health facility in time and they had to go for trial of home delivery first. In 25% cases their husband and family members did not agree to bring them to hospital, 31.3% was because of ignorance, 14% was due to economic constraints, 13.3% wanted to avoid operative delivery, 9.4 % patient herself did not agree to come to hospital because it would disrupt house hold work and the rest 7% could not come due to long distance between home and health center and tertiary hospital. Modes of delivery were LSCS in 85%, craniotomy in 9% and evisceration in 4%. Maternal outcome was WF in 7% and puerperial sepsis in 18%. Perinatal death was 45%, MMR was 3% due to obstructed labour.Conclusions:SThe causes of obstructed labour are not only due to medical causes but also have social causes. The social causes depend on the socio-economic status and the level of education

Obstructed Labour and Maternal Outcome at the Intensive Care Unit of the University of Port Harcourt Teaching Hospital: A Ten Year Review

ntroduction:Obstructed labour is a major cause of maternal mortality. Admissions into the intensive care unit (ICU) especially for post-delivery monitoring and treatment of patients with obstructed labour entails critical care for favourable outcome for the mother.Aim:To evaluate the maternal outcome of mothers admitted into the intensive care unit who had obstructed labour at the University of Port Harcourt Teaching Hospital (UPTH).Methodology:The study was a retrospective study of all the cases of obstructed labour admitted into the ICU of UPTH between 1stJanuary, 2007 to 31stDecember, 2016. Information were retrieved from the patients case note and analyzed using SPSS version 20.Results:A total of1549 patients were admitted into the ICU for the period under review, of which 218(14.1%) were obstetric admissions. One hundred and forty were unbooked mothers while 78 were booked. The mean age was 30 ± 2 years and the modal parity was 2. All the 64 cases of obstructed labour were unbooked mothers and comprised 29.4% of the obstetric admissions. The number of maternal deaths from obstructed labour were 23, which comprised of 10.6% of the obstetric admissions. Conclusion:The study revealed that the maternal deaths following obstructed labour admitted into the ICU was high. The reason is that these patients present late. There is therefore need for patients at risk of obstructed labour to register for antenatal care early and delivery conducted by skilledbirth attendant for improved outcome.

Obstructed labour at Usmanu Danfodiyo university teaching hospital Sokoto: a five-year review

Background: Obstructed labour is an obstetric emergency and one of the major causes of maternal and perinatal morbidity and mortality in the developing countries, Nigeria inclusive. The aim of this study was to determine the prevalence, causes and feto-maternal outcome of cases of obstructed labour managed at Usmanu Danfodiyo University Teaching Hospital Sokoto from 1st January, 2014 to 31st December, 2018.Methods: This was a retrospective review of all cases of obstructed labour managed at Usmanu Danfodiyo University Teaching Hospital Sokoto over 5 years. List of cases managed during the study period was obtained and case notes were retrieved. Relevant information such as age, booking status, parity, educational status, address, causes, mode of delivery and both maternal and foetal outcomes were obtained from the case notes. Data analysis was done using statistical package for social sciences version 22 (SPSS Inc, Chicago, IL, USA).Results: A total two hundred and seventy-six cases of obstructed labour were managed out of the 15,452 total deliveries during the study period. This gives an obstructed labour prevalence of 1.79%. The major cause of obstructed labour identified in this study was Cephalopelvic disproportion (74.6%) and majority of the patients were delivered by emergency lower segment caesarean section (70.6%). Up to 32.3% of the patients had no maternal complications and also 42.3% of them had live birth with no fetal complication. However, 20.2% of these patients had ruptured uterus and 37.9% of them had still birth, while 19.8% had live birth complicated by birth asphyxia.Conclusions: This study has found that obstructed labour resulted in adverse maternal and perinatal outcome. Hence, there is need to prevent obstructed labour in order to avert this consequence.

Foeto-Maternal Outcome of Obstructed Labour in a Tertiary Care Hospital of Kolkata

Obstructed labour is the situation where in spite of adequate uterine contraction the progressive decent of presenting part is arrested due to mechanical obstruction. Obstructed labour contributes to around eight percent of maternal deaths in India. It is also one of the leading causes of perinatal morbidity and mortality in developing countries. We wanted to study the risk factors and fetomaternal outcome in obstructed labour at Chittaranjan Seva Sadan College of Obstetrics, Gynaecology and Child Health. This will help us to assess obstetric near miss cases and to develop strategies to decrease the complications arising from obstructed labour.METHODSThis was a three year retrospective observational study conducted by reviewing the records of obstructed labour during the period April 2014 - March 2017. The study was approved by Institutional Ethics Committee. All the mothers who were admitted in the labour room with signs and symptoms of obstructed labour were included in this study. All the relevant information such as age, parity, socioeconomic status, risk factors, complications, mode of delivery, and fetomaternal outcome were collected.RESULTSThere were 219 cases of obstructed labour among a total of 23,815 deliveries. Most common cause for obstructed labour was cephalopelvic disproportion (77%) followed by malposition/malpresentation (17.3%). Majority of the patients (69.2%) belonged to poor socioeconomic group. Sepsis (10.6%) and pyrexia (9.6%) were the common complications. Neonatal mortality was 30.8% and maternal morbidity was 5.8%.CONCLUSIONSLack of health education, antenatal care, low socioeconomic condition, poor referral system and demographic factors are important contributory factors leading to adverse outcome of obstructed labour. This can be sorted out by proper antenatal care, improving health care delivery system and by timely referral of cases according to partograph monitoring.

Comparison of maternal and fetal morbidity between Patwardhan method of second stage lower segment caesarean section and conventional "push and pull" method

Background: To compare Maternal and fetal morbidity between Patwardhan method of second stage LSCS and conventional "push and pull" method.Methods: A retrospective study of all LSCS performed in second stage of labour consisted of all cases delivered by Patwardhan method compared with cases delivered by Push method during 3 years from January 2016 to December 2018 in Smt. Kashibai Navale Medical College Pune, Maharashtra, India.Results: A total of 89 patients underwent second stage LSCS from January 2016 to December 2018. A total of 37 patients were delivered by Patwardhan’s method and 52 patients were delivered by Push method. Uterine incision extension was more in the push and pull method when compared to Patwardhan technique. Same was true for the traumatic PPH blood transfusion which was significantly high in push and pull method as compared. Neonatal morbidity was significantly less in Patwardhan’s method as compared to Push method.Conclusions: As the maternal and fetal complications are seen to be considerably less in Patwardhan’s method than the conventional Push method our study concludes that Patwardhan’s method for delivering baby in second stage LSCS confers greater advantage.

Role of fetal craniotomy in modern day obstetrics: case series

Although obstructed labor in vanished from the western world where the destructive operations are obsolete and not needed, in developing countries like India obstructed labor with dead fetus and severe infection is a sad reality, and destructive operations are an essential part of obstetric practice and cannot be wished away. In many situations they should be a preferred option to cesarean delivery which needs much better facilities and greater morbidity. Here authors present a case series of three patients who reported with obstructed labour and IUFD. Fetal craniotomy was done and thus maternal morbidity reduced. Craniotomy offers less postpartum morbidity, lesser expertise and resources and therefore better in cases presenting with obstructed labour and dead baby in developing countries.

Maternal And Perinatal Outcome In Obstructed Labour

Background– Obstructed labour is a life threatening obstetric complication associated with significant maternal and fetal morbidity and mortality .Maternal mortality is largely due to PPH, puerperal infection or rupture uterus and perinatal mortality is mainly due to asphyxia. Methods– Prospective study of two years duration with sample comprised of 250 cases of obstructed labour randomly selected from all patients admitted to labour room with obstructed labour were included in this study. Results – The incidence of obstructed labour was 3.67% .72% were referral cases. Majority were primigravida(60.8% ) and between21–30 years(72.4%) .Common causes were Cephalopelvic disproportion( 54.4%) , malpresentation and malposition( 42%) and fetal malformation (1.6%).Delivery was by Caesarean section (80.4 %), forceps application ( 6.8 %)and destructive operations (1.6% ).Out of 28 cases of ruptured uterus,17 (6.8%) and11(4.4%) were managed by subtotal hysterectomy and uterine repair respectively.Maternal morbidity was 86.4% , causes being Puerperal pyrexia (37.6%) , post partum haemorrhage (20.8%) and wound infection (14.4%). Maternal deaths (1.6%) due to endotoxic shock and primary PPH.Perinatal mortality was21.14%. Commonest causes of neonatal morbidity were birth asphyxia (38.33%) of live births, jaundice (29.96%) ,septicaemia (18.94%) and Meconium aspiration syndrome (13.66%). Most of neonatal deaths were due to severe birth asphyxia (54.17%) followed by septicaemia (20.83%) Conclusion – Obstructed labour is a frequently encountered obstetric complication associated with very high maternal and perinatal morbidity and mortality. It can be prevented by providing good nutrition and optimal obstetric care .Effective antenatal care and early detection of risk factors and timely referral will prevent the complication due to obstructed labour.

Trapped after Coming Buttocks: A Consequence of Sacrococcygeal Teratoma: A Case Report.

Sacrococcygeal teratoma (SCT) is the commonest fetal tumour but a rare cause of obstructed labour. If undiagnosed during antenatal period, high index of suspicion is required during labour to make a diagnosis. In this case report, we present a case of sacrococcygeal teratoma (SCT) which was diagnosed at the time of delivery. The fetus, with a massive ruptured sacrococcygeal mass, was delivered by traction and suprapubic pressure. Histology report revealed malignant sacrococcygeal teratoma. The diagnosis of sacrococcygeal teratoma (SCT) should form part of the differential diagnoses when there is obstructed labour after the delivery of the fetal shoulders so that appropriate management can be instituted.

Genitourinary Fistula - An Experience from a Tertiary Care Hospital

Genito urinary fistula remains a frustrating condition for patients in the developing world. We retrospectively analysed twenty three women who underwent fistula repair over the last 5 years in one unit at Department of Obstetric and Gynaecology, All India Institute of Medical Sciences. Twenty-seven fistulae were repaired in 23 women of which 78.2% were vesecovaginal fistula. Majority of these fistula (73.9%) were obstetric in origin, as a result of neglected, mismanaged labour. Surgical repair was the mainstay with 100% success for those undergoing primary repair and an overall success rate of 83.3% for vesico vaginal fistula. Though principles of fistula repair were adhered to by the operating surgeon, each patient was unique. Surgeons trained in such repair can individually vary approach and technique to suit each patient giving high success rate.