Obstructed Labour

Obstructed Labour Obstructed Labour - An Avoidable Tragedy- An Avoidable Tragedy

&

DR. ANITA LENKA, M.B.B.S. Postgraduate

Dept. of Obstetrics and GynaecologyM.K.C.G. Medical College Hospital

Berhampur, Orissa, INDIABerhampur, Orissa, INDIA

PROF. SURENDRA NATH PANDA, M.S.

April 8, 2023 Obstructed Labour-An avoidable Tragedy--Prof.S.N.Panda & Dr Anita Lenka 2

Even in the 21st century, obstructed labour still remains a life-

threatening catastrophe all over the world mostly in the

developing countries. This entirely preventable labour

complication carrying a very high maternal and neonatal

morbidity and mortality is an indicator of the inadequacy and

poor quality of obstetric care.

Our hospital being a tertiary hospital, receives labour

patients in very late stage in very bad condition from whole of

south and southwest Orissa, one of the poorest regions of the

country. So, an attempt has been made to investigate this

unfortunate but almost entirely preventable complication of

labour.

INTRODUCTION


From October 1999 to December 2001, 256 cases of Obstructed Labour admitted in the Obstetrics and Gynaecology department of M.K.C.G Medical College Hospital, Berhampur, Orissa, were studied and the results of the analysis are presented here.

MATERIAL & METHODS


MAGNITUDE OF OBSTRUCTED LABOUR IN OUR HOSPITAL

EVENTS During 10/99 –12/01

TOTAL NO.

OBSTRUCTED LABOUR NO (%)

DELIVERIES 4107 256 (06.23)

CAESAREAN SECTION 1595 213 (13.35)

INSTRU. DELIV. 131 NIL NIL

RUPTURE UTERUS 37 26 (70.27)

OBST. HYSTERECTOMY 34 22 (64.71)

DESTRUCTIVE OPERATION 17 17 (100.00)

MATERNAL DEATH 98 04 (04.08)

LIVE BIRTH 3778 190 (05.03)

STILL BIRTH 340 67 (19.71)

NEONATAL DEATH 324 24 (07.41)


AGE AND PARITY OF PATIENTS

Parity >

Age in Yrs.

0 1 2 3 4+ Total

No. ( %)

<20 59 08 00 00 00 67 (26.17)

21-25 68 30 05 05 04 112 (43.75)

26-30 20 17 06 13 07 63 (24.61)

31-35 03 01 00 00 06 10 (03.91)

>35 00 00 02 00 02 04 (01.56)

Total

(%)

150

(58.59)

56

(21.88)

13

(5.08)

18

(7.03)

19

(7.42)

256 (100)


DEMOGRAPHIC PROFILE

CHARACTERISTICS NO ( %)RESIDENCE

RuralUrban

220 (85.94)36 (14.06)

LITERACYIlliterateLiterate

220 (87.94)31 (12.11)

SOCIO-ECONOMIC STATUSLowerMiddle

226 (88.28)30 (11.72)

A.N.C UnbookedBooked

234 (91.41)22 (08.56)


MATERNAL CONDITION AT ADMISSION

Condition At Admission Number ( % )

A-Minimal Obstruction, maternal condition Good

67 26.17

B-Moderate Obstruction, maternal condition Good

32 12.50

C-Mod / Severe Obstruction, maternal condition Bad

139 54.30

D-Rupture Uterus 18 07.03

Total 256 100


DURATION OF LABOUR AND RUPTURE OF MEMBRANE AT ADMISSION

Dur. in Hrs Labour

NO. (%)

Rupt.of Memb.

NO. (%)

12 or less 37 (14.45) 124 (59.05)

13-18 69 (26.96) 53 (25.23)

19-24 70 (27.34) 26 (8.09)

25 or more 80 (31.25) 53 (7.62)

Total 256 256


CAUSES OF OBSTRUCTED LABOUR

Cause No. (%) Cause No, (%)

CPD 140 (54.69) TWIN

Locked ------1

Conjoined---1

2 (0.95)

DTA 45 (17.58) BROW 1 (0.47)

TRANS. LIE 33 (12.89) HYDROCEP. 1 (0.47)

OCC.POST. 17 (6.64) COMP.PRES. 1 (0.47)

NON DILA. OF CX. 9 (3.52) FOE. ASCITES 1 (0.47)

BREECH 3 (1.17) CX. FIBROID 1 (0.47)

FACE

(Mento-Posterior)

2 (0.78)

TOTAL 256


MODE OF DELIVERY

CAESAREAN SECTION 213* 83.20% Live Births 190+ Still Births 24+ Neonatal Death 24

DESTRUCTIVE OPERATIONS 17 06.64% Craniotomy 06 Evisceration 08

RUPTURED UTERUS 26 10.16% Hysterectomy 22 Repair 04

TOTAL 256

*One patient underwent hysterectomy on 9th day for infection & gangrene+Includes one twin delivery of live & still birth


MATERNAL MORBIDITY AND MORTALITY MORBIDITY No. (%) MORBIDITY No. (%)

Pyrexia 128 (50.00) Broad Ligament Haematoma

12 (4.69)

P.P.H 85 (33.20) Pritonitis 6 (2.34)

Blood trans. 65 (25.39) Shock 5 (1.95)

Wound Inf. 45 (7.14) Paralytic ileus 3 (1.42)

U.T.I 25 (9.52) Pneumonia 3 (1.42)

Sub involution 24 (9.77) V.V.F. 2 (0.78

Thrombophleb. 14 (5.71) Burst abdomen 1 (1.42)

No.Of Morbid Pts. 226 (88.28) DEATHS 4 (1.42 )


NEONATAL MORBIDITY AND MORTALITY IN 161 LIVE BIRTHS

MORBIDITY No. ( % ) DEATH

Birth Asphyxia 74 (38.95) 13

Septicemia 31 (19.25) 6

Meconium Aspiration Syndrome 28 (4.74) 3

Convulsion 10 (5.26) 2

Jaundice 59 (36.64) 0

Umbilical Sepsis 12 (6.32) 0

Diarrhoea 4 (2.48) 0

Facial Injury 3 (1.580

Cephlohaematoma 2 (1.05)

NEONATES WITH MORBIDITY 156 (82.11) 24


These tragic case histories bear testimony to the fact that obstructed labour is the result of multi level deficiencies in our health care delivery system.

Once this complication arise, swift access to high quality professional treatment is essential, if lives are to be saved.

However more importantly it is essential that all efforts should be made to prevent the occurrence of the complications in the first place.

For this we have to improve the socio-economic environment of the women.

There is need for information on existing facilities, utilization of facilities, changing demands and accessibility and availability of efficacious and safe obstetric care

CONCLUSION


To decrease this unfortunate & mostly preventable

obstetric complication, restructuring of M.C.H. Services

should be done with particular attention to: -

Increasing community awareness

Promotion of appropriate technology and

Effective health care planning starting from grassroots

levels to tertiary levels

Establishment of an streamlined and effective referral

system

CONCLUSION


LET US MAKE MOTHERHOOD SAFE

This Paper was presented at the 45th All India Obstetric and Gynaecological Congress at Bhubaneswar on 07-01-2002

Obstructed Labour

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