1. Obstructed Labour
&
Prolonged Labour

2. Determinants of Successful Labour
► Adequate Power (uterine contractions)
► Adequate Passage (maternal pelvis)
► Adequate Passenger (fetal size)
DEFINITION OF PROLONGED LABOUR
When labour tends to be prolonged for more
than 18 hours both in primigravida and
multigravida women

3. Causes ►Fault in passenger ►Fault in power :
►Fault in passage
►Fault in passenger
►Fault in power :
▪ Hypotonic Uterine Dysfunction (inertia)
►Can be 2ry to Epidural analgesia or
Chorioamnionitis
▪ Hypertonic / Incoordinate Uterine function

4. Diagnosis History: 1.Age 2.Parity 3.Duration of labour
4.Duration of membrane rupture
5.Whether the patients was handle outside the hospital
6.Whether she was treated with oxytocin drugs
7.Previous history of difficult labour, instrumental delivery
or stillbirth

5. Abdominal examination:
1. Contour of the uterus
2. Presentation & position
3. Tenderness
4. Frequency, intensity & duration of uterine
contraction
5. Lower segment distended
6. Distension of the bladder

6. Vaginal examination: - The vulva usually swollen and edematous.
- The vaginal is dry, hot and occasionally
offensive and purulent discharge
- The cervix is almost fully dilated
- The presenting part is extremely moulded
and jammed in the pelvis
- There is usually large caput formation

7. Management A. General management :
1. NPO & i/v fluid start immediately
2. Bladder evacuation.
3. Parenteral antibiotics.
4. Intake output chart should be strictly maintain
5. Blood should be send for grouping and cross matching

8. Obstetric Management During 1st stage:
1. Role of oxytocin : hypotonic uterine contraction
Role of sedation : incordinate uterine contraction use of narcotics may lead to spontaneous correction
Role of amniotomy in correction of hypotonic uterine contraction
4. Role of cesarean section: contracted pelvis, big baby, malpresentation, malposition, severe fetal distress

9. During 2nd stage: 1. Role of episiotomy: rigid / tight perineum
2. Role of instrumental delivery (Forceps or
Vacuum): in case of fetal distress,
3. Role of cesarean section: contracted pelvis,
big baby, malpresentation, malposition, and
severe fetal distress

10. Complications Fetal: Immediate: - Birth trauma - Birth asphyxia
- Fetal distress
- Meconium aspiration syndrome
- Stillbirth
- Neonatal death !
Late:
- Cerebral palsy
- Mental retardation
Maternal:
Immediately:
-Maternal distress
-Maternal injury
-PPH
-Puerperal sepsis
-Maternal death
Late:-
-Urinary fistula
-Vaginal stenosis
-Secondary infertility

11. Obstructed labour
►Definition : defined as labour where there is poor or no progress of labour in spite of good uterine contraction!
►Incidence :- 1 -2% of cases in developing country

12. Causes ►Maternal condition (fault in the passage): 1. Contracted pelvi
2. Abnormal pelvis: android, anthropoid
3. Pelvic tumor: fibroid, ovarian tumor
4. Tumor of rectum, bladder or pelvic bone
5. Abnormality in uterus & vagina: scarring in cervix, vaginal septum, rigid perineum

13. fetal causes
Big baby
Big head, hydrocephalus
Deflexed head, brow and face mentoposterior.
Oblique or transverse lie

14. Diagnosis
►Partograph will recognize impending obstruction of labour early
►Careful general, abdominal and vaginal
examination can detect if labour is slow or
no progress

15. General examination: Features of maternal distress Dehydration
Tachycardia >100/m
Raise temperature
Scanty urine

16. Abdominal examination :
-The retraction ring might appear and felt
between the tonically contracted upper
segment of the uterus and the distended
lower segment
- Distended urinary bladder

18. Vaginal examination: - The vulva usually swollen and edematous
- The vaginal can be dry and hot
- The cervix is almost fully dilated or hanging
like a curtain
- The presenting part is extremely moulded
and jammed in the pelvis
- There is usually large caput formation

19. Complication Maternal: ! -Rupture of uterus -Urogenital fistula
-Rectovaginal fistula
-Postpartum hemorrhage
-Puerperal sepsis
-Shock
-Maternal death
Fetal:
-Intra uterine asphyxia
-Intracranial hemorrhage
-Neonatal infection
-Metabolic Acidosis
-Fetal death

20. Management ►Preventive:
- Proper assessment of pregnant woman during ANC
- Regular ANC visit
- Proper assessment in early labour to
- Use of Partogram
- Prompt and appropriate treatment

21. Obstetric Management 1. Delivery of fetus:
a. Vaginal delivery: if head is low and vaginal delivery
is not risky, forceps extraction may be done
b. Caesarean section:
2. Active management of 3rd stage of labour
3. Continuous bladder drainage for 2-3 days to
prevent any urogenital fistula