1. Obstructed Labour - An Avoidable Tragedy

2. 11 November November 2017
Obstructed Labour-An avoidable Tragedy--Prof.S.N.Panda & Dr Anita Lenka

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

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

5. MAGNITUDE OF OBSTRUCTED LABOUR IN OUR HOSPITAL
EVENTS
During 10/99 –12/01
TOTAL NO.
OBSTRUCTED LABOUR NO (%)
DELIVERIES
4107
(06.23)
CAESAREAN SECTION
1595
(13.35)
INSTRU. DELIV.
131
NIL NIL
RUPTURE UTERUS 37
(70.27)
OBST. HYSTERECTOMY 34
(64.71)
DESTRUCTIVE OPERATION 17
(100.00)
MATERNAL DEATH 98
(04.08)
LIVE BIRTH
3778
(05.03)
STILL BIRTH
340
(19.71)
NEONATAL DEATH
324
(07.41)
11 November November 2017
Obstructed Labour-An avoidable Tragedy--Prof.S.N.Panda & Dr Anita Lenka

6. 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)
(100)
11 November November 2017
Obstructed Labour-An avoidable Tragedy--Prof.S.N.Panda & Dr Anita Lenka

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

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

9. 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)
(8.09)
25 or more
80 (31.25)
(7.62)
Total
256
11 November November 2017
Obstructed Labour-An avoidable Tragedy--Prof.S.N.Panda & Dr Anita Lenka

10. CAUSES OF OBSTRUCTED LABOUR
No. (%)
No, (%)
CPD
140 (54.69)
TWIN
Locked
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 November 2017
Obstructed Labour-An avoidable Tragedy--Prof.S.N.Panda & Dr Anita Lenka

11. MODE OF DELIVERY CAESAREAN SECTION 213* 83.20%
Live Births
Still Births
Neonatal Death
DESTRUCTIVE OPERATIONS %
Craniotomy
Evisceration
RUPTURED UTERUS %
Hysterectomy
Repair
TOTAL
*One patient underwent hysterectomy on 9th day for infection & gangrene
+Includes one twin delivery of live & still birth
11 November November 2017
Obstructed Labour-An avoidable Tragedy--Prof.S.N.Panda & Dr Anita Lenka

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

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

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

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

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