Obstructed Labour - An Avoidable Tragedy

11 November 201711 November 2017 Obstructed Labour-An avoidable Tragedy--Prof.S.N.Panda & Dr Anita Lenka

INTRODUCTION 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. 11 November 201711 November 2017 Obstructed Labour-An avoidable Tragedy--Prof.S.N.Panda & Dr Anita Lenka

MATERIAL & METHODS 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. 11 November 201711 November 2017 Obstructed Labour-An avoidable Tragedy--Prof.S.N.Panda & Dr Anita Lenka

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) 11 November 201711 November 2017 Obstructed Labour-An avoidable Tragedy--Prof.S.N.Panda & Dr Anita Lenka

AGE AND PARITY OF PATIENTS Age in Yrs. 1 2 3 4+ Total No. ( %) <20 59 08 00 67 (26.17) 21-25 68 30 05 04 112 (43.75) 26-30 20 17 06 13 07 63 (24.61) 31-35 03 01 10 (03.91) >35 02 04 (01.56) (%) 150 (58.59) 56 (21.88) (5.08) 18 (7.03) 19 (7.42) 256 (100) 11 November 201711 November 2017 Obstructed Labour-An avoidable Tragedy--Prof.S.N.Panda & Dr Anita Lenka

DEMOGRAPHIC PROFILE CHARACTERISTICS NO ( %) RESIDENCE Rural Urban 220 (85.94) 36 (14.06) LITERACY Illiterate Literate 220 (87.94) 31 (12.11) SOCIO-ECONOMIC STATUS Lower Middle 226 (88.28) 30 (11.72) A.N.C Unbooked Booked 234 (91.41) 22 (08.56) 11 November 201711 November 2017 Obstructed Labour-An avoidable Tragedy--Prof.S.N.Panda & Dr Anita Lenka

MATERNAL 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 11 November 201711 November 2017 Obstructed Labour-An avoidable Tragedy--Prof.S.N.Panda & Dr Anita Lenka

DURATION OF LABOUR AND RUPTURE OF MEMBRANE AT ADMISSION Dur. in Hrs Labour NO. (%) Rupt.of Memb. 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 11 November 201711 November 2017 Obstructed Labour-An avoidable Tragedy--Prof.S.N.Panda & Dr Anita Lenka

CAUSES OF OBSTRUCTED LABOUR No. (%) 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. OCC.POST. 17 (6.64) COMP.PRES. NON DILA. OF CX. 9 (3.52) FOE. ASCITES BREECH 3 (1.17) CX. FIBROID FACE (Mento-Posterior) 2 (0.78) TOTAL 256 11 November 201711 November 2017 Obstructed Labour-An avoidable Tragedy--Prof.S.N.Panda & Dr Anita Lenka

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 11 November 201711 November 2017 Obstructed Labour-An avoidable Tragedy--Prof.S.N.Panda & Dr Anita Lenka

MATERNAL MORBIDITY AND MORTALITY No. (%) 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 Sub involution 24 (9.77) V.V.F. 2 (0.78 Thrombophleb. 14 (5.71) Burst abdomen 1 (1.42) No.Of Morbid Pts. (88.28) DEATHS 4 (1.42 ) 11 November 201711 November 2017 Obstructed Labour-An avoidable Tragedy--Prof.S.N.Panda & Dr Anita Lenka

NEONATAL MORBIDITY AND MORTALITY IN 161 LIVE BIRTHS 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) Umbilical Sepsis 12 (6.32) Diarrhoea 4 (2.48) Facial Injury 3 (1.580 Cephlohaematoma 2 (1.05) NEONATES WITH MORBIDITY 156 (82.11) 24 11 November 201711 November 2017 Obstructed Labour-An avoidable Tragedy--Prof.S.N.Panda & Dr Anita Lenka

CONCLUSION 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 11 November 201711 November 2017 Obstructed Labour-An avoidable Tragedy--Prof.S.N.Panda & Dr Anita Lenka

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 11 November 201711 November 2017 Obstructed Labour-An avoidable Tragedy--Prof.S.N.Panda & Dr Anita Lenka

Thank you LET US MAKE MOTHERHOOD SAFE This Paper was presented at the 45th All India Obstetric and Gynaecological Congress at Bhubaneswar on 07-01-2002 11 November 201711 November 2017 Obstructed Labour-An avoidable Tragedy--Prof.S.N.Panda & Dr Anita Lenka