1. Obstructed Labor
&
Prolonged Labur

2. Objective Determine the factors affecting normal labor
Early diagnosis of abnormal labor
How to manage abnormal or prolonged labor.
Identify the complications of prolonged labor.

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

4. 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
Chorio amnionitis
▪ Hypertonic / In coordinate Uterine function

5. Diagnosis History: 1.Age 2.Parity 3.Duration of labor
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 labor, instrumental delivery
or stillbirth

6. 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

7. 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 molded
and jammed in the pelvis
- There is usually large caput formation

8. 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

9. Obstetric Management During 1st stage:
1. Role of oxytocin : hypotonic uterine contraction
Role of sedation : incoordinate 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

10. 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

11. 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

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

13. Causes ►Maternal condition (fault in the passage):
1. Contracted pelvis
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

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

15. Diagnosis
►Partogram will recognize impending obstruction of labor
►Careful general, abdominal and vaginal
examination can detect if labor is slow or
no progress

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

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

19. 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 molded
and jammed in the pelvis
- There is usually large caput formation

20. 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

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

22. 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 labor
3. Continuous bladder drainage for 2-3 days to
prevent any urogenital fistula