By: Adesua Oni
Obstructed labor, also known as dystocia, is a condition in which the fetus is unable to pass through the birth canal due to mechanical obstruction. This can be caused by a variety of factors, including abnormal fetal position, maternal pelvic abnormalities, or large fetal size.
Signs of Obstructed labor.
The following are some signs of obstructed labor in pregnant women:
Prolonged labor: One of the most common signs of obstructed labor is prolonged labor, also known as a prolonged second stage of labor. This is defined as a stage of labor lasting more than 3 hours in nulliparous women or more than 2 hours in multiparous women. Prolonged labor can lead to fetal distress, maternal exhaustion, and an increased risk of infection.
Failure of descent: Another sign of obstructed labor is the failure of descent, which occurs when the fetus does not descend into the pelvis despite strong contractions. This can be caused by a variety of factors, including a large fetal size, abnormal fetal position, or maternal pelvic abnormalities.
Abnormal fetal heart rate: Obstructed labor can also cause abnormal fetal heart rate patterns, which may indicate fetal distress. Fetal distress can occur due to decreased oxygen supply to the fetus, which can result from prolonged labor, uterine hyperstimulation, or compression of the umbilical cord.
Maternal exhaustion: Obstructed labor can cause maternal exhaustion, which can lead to a decrease in the strength and frequency of contractions. This can result in prolonged labor and an increased risk of infection.
Maternal fever: Obstructed labor can also cause maternal fever, which may indicate an infection. Infection can occur due to prolonged labor, prolonged rupture of membranes, or the use of invasive procedures such as fetal scalp electrodes or intrauterine pressure catheters.
It is important to note that these signs do not always indicate obstructed labor and may be present in other conditions as well. Therefore, a proper diagnosis and management plan should be made by a qualified healthcare professional.
Causes of Obstructed Labour
Obstructed labor can have a variety of causes that prevent the fetus from descending through the birth canal.
These causes can be related to the fetus, the mother, or the environment in which the delivery takes place. Here are some common causes of obstructed labor:
Fetal size and position: The size and position of the fetus can have a significant impact on the progress of labor. A large fetal size, such as in cases of fetal macrosomia, can make it difficult for the fetus to pass through the pelvis. Abnormal fetal positions, such as breech or transverse positions, can also cause obstruction and prevent the fetus from descending through the birth canal.
Maternal pelvic abnormalities: Maternal pelvic abnormalities, such as a contracted pelvis, can also cause obstructed labor. This can make it difficult or impossible for the fetus to pass through the pelvis.
Previous pelvic surgery: Previous pelvic surgery, such as a cesarean section or pelvic reconstructive surgery, can cause scarring and adhesions that can obstruct the birth canal.
Uterine abnormalities: Uterine abnormalities, such as a bicornuate or septate uterus, can also cause obstructed labor by preventing the fetus from descending through the birth canal.
Malposition or malpresentation of the fetal head: In some cases, the fetal head may be in a malposition or malpresentation, which can obstruct the birth canal.
Inefficient contractions: Inefficient contractions or weak uterine contractions can also cause obstructed labor, as they may not provide enough force to push the fetus through the birth canal.
Maternal exhaustion: Maternal exhaustion, caused by prolonged labor or inadequate pain relief, can lead to weak contractions and obstructed labor.
Maternal health conditions: Certain maternal health conditions, such as obesity, diabetes, or hypertension, can increase the risk of obstructed labor.
It is important to note that obstructed labor can have serious consequences for both the mother and the fetus, and timely intervention is essential to ensure safe delivery. Management may include medical or surgical interventions, such as induction of labor, assisted vaginal delivery, or cesarean section.
Management Of Obstructed Labour
Obstructed labor is a medical emergency that requires prompt intervention to prevent maternal and fetal morbidity and mortality. The management of obstructed labor in pregnant women involves a multidisciplinary approach that includes medical and nursing management.
Medical Management:
Identification of obstructed labor: The first step in the management of obstructed labor is to identify the condition. The signs and symptoms of obstructed labor include prolonged labor, failure of descent of the fetal head, fetal distress, and maternal exhaustion. Once the condition is identified, immediate intervention is required.
Resuscitation and stabilization of the patient: Patients with obstructed labor often present with dehydration, hypovolemia, and electrolyte imbalances. The initial management involves resuscitation and stabilization of the patient by providing intravenous fluids, oxygen, and electrolyte replacement therapy.
Vaginal examination: A vaginal examination is performed to assess cervical dilatation, fetal presentation, and station. The degree of obstruction and the position of the fetus determines the mode of delivery.
Conservative management: Conservative management involves attempts to facilitate vaginal delivery by applying forceps or vacuum extraction. However, if these methods fail, an emergency cesarean section is indicated.
Cesarean section: Emergency cesarean section is indicated if conservative measures fail or if there is evidence of fetal distress. In cases of obstructed labor, the decision to perform a cesarean section should be made promptly to prevent maternal and fetal complications.
Nursing Management:
-Frequent monitoring: The patient with obstructed labor requires frequent monitoring of vital signs, fetal heart rate, and contractions. The nursing staff should closely monitor the progress of labor and report any signs of fetal distress.
Pain management: Pain management is essential in the management of obstructed labor. The nursing staff should administer analgesics as prescribed and provide emotional support to the patient.
Hydration and nutrition: Patients with obstructed labor are at risk of dehydration and malnutrition. The nursing staff should ensure adequate hydration and nutrition by providing intravenous fluids and a balanced diet.
Post-operative care: Patients who undergo emergency cesarean section require post-operative care. The nursing staff should monitor the patient’s vital signs, and wound healing, and provide pain management.
References:
Cunningham FG, Leveno KJ, Bloom SL, et al. Williams Obstetrics. 24th ed. New York, NY: McGraw-Hill Education; 2014.
Cunningham, F. G., Leveno, K. J., Bloom, S. L., Spong, C. Y., Dashe, J. S., Hoffman, B. L., … & Casey, B. M. (2018). Williams obstetrics. McGraw Hill Professional.
American College of Obstetricians and Gynecologists. (2014). Practice bulletin no. 154: Operative vaginal delivery. Obstetrics and Gynecology, 123(3), 698-708.
World Health Organization. Managing complications in pregnancy and childbirth: a guide for midwives and doctors. 2nd ed. Geneva, Switzerland: World Health Organization; 2017
