Obstructed labour

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Presentation Description

Obstructed labour is when the presenting part of the fetus cannot progress into the birth canal, despite strong uterine contractions.

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Presentation Transcript

OBSTRUCTED LABOUR: 

OBSTRUCTED LABOUR 3/24/2014 1

OBSTRUCTED LABOUR: 

OBSTRUCTED LABOUR 3/24/2014 2 Dr Balina Moses balinamoses@gmail.com http://balinamoses.blogspot.com

Contents: 

Contents Definition Epidemiology Causes Clinical features Differential diagnosis Investigations Management Complications Prevention Prognosis 3/24/2014 3

PowerPoint Presentation: 

Normal Labour 3/24/2014 4

Case: 

Case A 34 year old female, with a known uterine septum, G5P4+0 came to the maternity ward at 39 weeks with regular UCs. Exam showed footling breech. Cervix was 6cm long with bulging membranes. While examining, the BOW suddenly ruptured and a loop of umbilical cord protruded through the cervix between the fetal extremities. 3/24/2014 5

Definition: 

Definition Obstructed labour is the failure of the presenting part of the fetus to descend through the birth canal, because there is an impossible barrier preventing its descent, despite strong uterine contractions. 3/24/2014 6

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3/24/2014 7 Epidemiology KIUTH – Kampala International University Teaching Hospital

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3/24/2014 8 Epidemiology KIUTH – Kampala International University Teaching Hospital

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Epidemiology 3/24/2014 9

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Epidemiology 3/24/2014 10

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Epidemiology 3/24/2014 11

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World wide Prevalence is 2-8% Maternal mortality rate is 8% Epidemiology 3/24/2014 12

Causes of obstructed labour: 

Causes of obstructed labour Powers 3/24/2014 13

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Causes of obstructed labour 3/24/2014 14

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Causes of obstructed labour 3/24/2014 15

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Causes of obstructed labour 3/24/2014 16

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Causes of obstructed labour 3/24/2014 17

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Causes of obstructed labour 3/24/2014 18

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Causes of obstructed labour 3/24/2014 19

Causes of obstructed labour: 

Powers Passenger Causes of obstructed labour 3/24/2014 20

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Hydrocephalus Causes of obstructed labour 3/24/2014 21

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Malposition Malpresentation Causes of obstructed labour 3/24/2014 22

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Shoulder Dystocia Causes of obstructed labour 3/24/2014 23

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Conjoined Twins Causes of obstructed labour 3/24/2014 24

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Conjoined Twins Causes of obstructed labour 3/24/2014 25

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Conjoined Twins Causes of obstructed labour 3/24/2014 26

Causes of obstructed labour: 

Powers Passenger Passage Causes of obstructed labour 3/24/2014 27

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Inadequate Pelvis Causes of obstructed labour 3/24/2014 28

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Umbilical Cord Prolase Causes of obstructed labour 3/24/2014 29

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Female Circumcision Causes of obstructed labour 3/24/2014 30

Clinical features: 

Prolonged labour Mother appears weak Abnormal vital signs 3/24/2014 31 Clinical features General examination

Clinical features: 

Malpresentation Bandl’s ring 3/24/2014 32 Clinical features Abdominal examination

Clinical features: 

Clinical features 3/24/2014 33 Abdominal examination Bandl’s ring

Clinical features: 

Foul smelling meconium Oedema of the vulva and cervix Caput on the fetal head 3/24/2014 34 Clinical features Vaginal examination

Differential diagnosis: 

Full bladder Fundal myoma 3/24/2014 35 Differential diagnosis

Investigations: 

3/24/2014 36 Investigations Partograph

Investigations: 

Investigations CBC Serum electrolytes Sonography TAUS 3/24/2014 37 Blood Imaging

Management: 

Rehydration Catheterization Caesarean delivery 3/24/2014 38 Management

Complications: 

Fistula PPH Slow involution Shock Paralytic ileus Sepsis Death 3/24/2014 39 Complications Maternal

Complications: 

Neonatal sepsis Convulsions Facial injury Severe asphyxia Death 3/24/2014 40 Complications Fetal

Prevention: 

Skilled birth attendance Using the partograph Birth preparedness Nutritional education Delaying early marriage 3/24/2014 41 Prevention

Prognosis: 

The prognosis of subsequent pregnancies depends on the cause for obstructed labour. 3/24/2014 42 Prognosis