Obstructed labour | |
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Other names | Labour dystocia |
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Illustration of deformed pelvises. A deformed pelvis is a risk factor for obstructed labour | |
Specialty | Obstetrics |
Complications | Perinatal asphyxia, uterine rupture, post-partum bleeding, postpartum infection[1] |
Causes | Large or abnormally positioned baby, small pelvis, problems with the birth canal[2] |
Risk factors | Shoulder dystocia, malnutrition, vitamin D deficiency[3][2] |
Diagnostic method | Active phase of labour > 12 hours[2] |
Treatment | Cesarean section, vacuum extraction with possible surgical opening of the symphysis pubis[4] |
Frequency | 6.5 million (2015)[5] |
Deaths | 23,100 (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]
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