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Obstructed labour

Obstructed labour
Other namesLabour dystocia
Illustration of deformed pelvises. A deformed pelvis is a risk factor for obstructed labour
SpecialtyObstetrics
ComplicationsPerinatal asphyxia, uterine rupture, post-partum bleeding, postpartum infection[1]
CausesLarge or abnormally positioned baby, small pelvis, problems with the birth canal[2]
Risk factorsShoulder dystocia, malnutrition, vitamin D deficiency[3][2]
Diagnostic methodActive phase of labour > 12 hours[2]
TreatmentCesarean section, vacuum extraction with possible surgical opening of the symphysis pubis[4]
Frequency6.5 million (2015)[5]
Deaths23,100 (2015)[6]

Obstructed labour, also known as labour dystocia, is the baby not exiting the pelvis because it is physically blocked during childbirth although the uterus contracts normally.[2] Complications for the baby include not getting enough oxygen which may result in death.[1] It increases the risk of the mother getting an infection, having uterine rupture, or having post-partum bleeding.[1] Long-term complications for the mother include obstetrical fistula.[2] Obstructed labour is said to result in prolonged labour, when the active phase of labour is longer than 12 hours.[2]

The main causes of obstructed labour include a large or abnormally positioned baby, a small pelvis, and problems with the birth canal.[2] Abnormal positioning includes shoulder dystocia where the anterior shoulder does not pass easily below the pubic bone.[2] Risk factors for a small pelvis include malnutrition and a lack of exposure to sunlight causing vitamin D deficiency.[3] It is also more common in adolescence as the pelvis may not have finished growing by the time they give birth.[1] Problems with the birth canal include a narrow vagina and perineum which may be due to female genital mutilation or tumors.[2] A partograph is often used to track labour progression and diagnose problems.[1] This combined with physical examination may identify obstructed labour.[7]

The treatment of obstructed labour may require cesarean section or vacuum extraction with possible surgical opening of the symphysis pubis.[4] Other measures include: keeping the women hydrated and antibiotics if the membranes have been ruptured for more than 18 hours.[4] In Africa and Asia obstructed labor affects between two and five percent of deliveries.[8] In 2015 about 6.5 million cases of obstructed labour or uterine rupture occurred.[5] This resulted in 23,000 maternal deaths down from 29,000 deaths in 1990 (about 8% of all deaths related to pregnancy).[2][6][9] It is also one of the leading causes of stillbirth.[10] Most deaths due to this condition occur in the developing world.[1]

  1. ^ a b c d e f Neilson JP, Lavender T, Quenby S, Wray S (2003). "Obstructed labour". British Medical Bulletin. 67: 191–204. doi:10.1093/bmb/ldg018. PMID 14711764.
  2. ^ a b c d e f g h i j Education material for teachers of midwifery : midwifery education modules (PDF) (2nd ed.). Geneva [Switzerland]: World Health Organization (WHO). 2008. pp. 17–36. ISBN 978-92-4-154666-9. Archived (PDF) from the original on 2015-02-21.
  3. ^ a b Education material for teachers of midwifery : midwifery education modules (PDF) (2nd ed.). Geneva [Switzerland]: World Health Organization (WHO). 2008. pp. 38–44. ISBN 978-92-4-154666-9. Archived (PDF) from the original on 2015-02-21.
  4. ^ a b c Education material for teachers of midwifery : midwifery education modules (PDF) (2nd ed.). Geneva [Switzerland]: World Health Organization (WHO). 2008. pp. 89–104. ISBN 978-92-4-154666-9. Archived (PDF) from the original on 2015-02-21.
  5. ^ a b Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. (GBD 2015 Disease and Injury Incidence and Prevalence Collaborators) (October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
  6. ^ a b Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. (GBD 2015 Mortality and Causes of Death Collaborators) (October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/s0140-6736(16)31012-1. PMC 5388903. PMID 27733281.
  7. ^ Education material for teachers of midwifery : midwifery education modules (PDF) (2nd ed.). Geneva [Switzerland]: World Health Organization (WHO). 2008. pp. 45–52. ISBN 978-92-4-154666-9. Archived (PDF) from the original on 2015-02-21.
  8. ^ Usha K (2004). Pregnancy at risk : current concepts. New Delhi: Jaypee Bros. p. 451. ISBN 978-81-7179-826-1. Archived from the original on 2016-03-04.
  9. ^ GBD 2013 Mortality Causes of Death Collaborators (January 2015). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013". Lancet. 385 (9963): 117–71. doi:10.1016/S0140-6736(14)61682-2. PMC 4340604. PMID 25530442. |Supplementary Appendix Page 190 {{cite journal}}: |author1= has generic name (help); External link in |quote= (help)CS1 maint: numeric names: authors list (link)
  10. ^ Goldenberg RL, McClure EM, Bhutta ZA, Belizán JM, Reddy UM, Rubens CE, et al. (May 2011). "Stillbirths: the vision for 2020". Lancet. 377 (9779): 1798–805. doi:10.1016/S0140-6736(10)62235-0. hdl:11336/192198. PMID 21496912. S2CID 26968628.

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