Obg Seminar-obstructed Labor

ASSAM OIL COLLEGE OF NURSING
SEMINAR ON-
OBSTRUCTED LABOR
SUB: MIDWIFERY AND OBSTETRICAL
NURSING
PRESENTED TO: PRESENTED

BY:
Respected ma’am Ruplan
Engtipi
Mrs. Banashri Saikia Roll no:24
Clinical Instructor B.Sc (N) 4th
Year.
(Gynae & OBG)
INTRODUCTION
DEFINITION
 Obstructed labor is define as, where inspite
of good uterine contractions, the progressive
descent of the presenting part is arrested
due to mechanical obstruction.
 Labor is said to be obstructed where there is

absence of progress in the presence of strong
uterine contraction.
INCIDENCE
 WORLDWIDE
 Obstructed labor affects 3-6% of laboring
women in developing countries.
 Obstructed labor is responsible for 22% of
obstetrical complication, 9% of all maternal
deaths in low and middle income countries.
 IN INDIA
 Obstructed labor is seen between 0.65-1.89%
of all deliveries in the referral hospital of
India.
 Obstructed labor is the leading cause of
hospitalization comprising upto 39% of all
obstetric patients.
RELATED ANATOMY AND
PHYSIOLOGY
FUNCTION OF PELVIS
1. Its bear the weight of the body when
the individual is seated.
2. It contain and protect the bladder,
rectum and the internal reproductive
organ.
3. Its only obstetric function is to support
the enlarged uterus during the
pregnancy.
DIAMETER OF PELVIS
PHYSIOLOGAL ENLARGEMENT OF PELVIS
DURING PREGNANCY AND LABOR
 Imaging studies show an increases in width
and mobility of the symphysis pubis during
pregnancy which returns to normal following
delivery.
 Pubic bones is separated by 5 to 10 mm.
 Increase of antero-posterior diameter of the
inlet by rotatory movement of the sacroiliac
joints.
 In dorsal lithotomy position, the antero-
posterior diameter of the outlet increase to 1.5
to 2 cm.
 Coccyx is pushed back while the head
descends down to the perineum.
ETIOLOGY
1. FAULT IN THE PASSAGE:
A) BONY OBSTRUCTION:
 Cephalopelvic disproportion (CPD).
 Contracted pelvis.
B) SOFT TISSUE OBSTRUCTION:
 Uterus: impacted subserous
pedunucleated fibroid,
constriction ring opposite the neck of the
fetus.
 Cervix: Cervical dystocia.
 Vagina: septa, stenosis, tumors.
 Ovaries: impacted ovarian tumors.
2. FAULT IN THE PASSENGER:
A) SIZE OF HEAD:
 Large fetal head( big for that pelvis).
 Hydrocephalus.
B) TWIN PREGNANCY:
 Locked twins.
 Conjoined twins.
C) PRESENTATION & POSITION:
3. POWERS:
 Inadequate power, due to poor or uncoordinated
uterine contractions.
 Either the uterine contractions are not strong
enough to efface and dilate the cervix in the first

stage of labor or the muscular effort of the
uterus is insufficient to push the baby down the
birth canal.
PHYSIOLOGY OF
OBSTRUCTED LABOR
CLINICAL MANIFESTATION
IMPACT OF
OBSTRUCTED LABOR
EFFECTS ON THE MOTHER-
IMMEDIATE REMOTE
1. Exhaustion. 1. Genitourinary
2. Dehydration. fistula or
rectovaginal
3. Metabolic acidosis.
fistula.
4. Genital sepsis.
2. Vaginal atresia.
5. Injury to the
3. Secondary
genital tract
amenorrhea.
includes rupture of
the uterus.
6. PPH and shock.
 EFFECT ON THE FETUS-
1. Asphyxia
2. Acidosis.
3. Intracranial hemorrhage.
4. Infection.
MANAGEMENT OF OBSTRUCTED
LABOR
 PREVENTION
 ACTUAL TREATMENT
ACTUAL TREATMENT
 The underlying principles are:
1. to relieve the obstruction at the earliest by a
safe delivery procedure.
2. to combat dehydration and ketosis.
3. to control sepsis.
PRELIMINARIES-
1. Fluid – electrolyte balance , correction of
dehydration and ketoacidosis.
RL ; 1 litre in running drip.
3 litre fluid is required to correct clinical
dehydration.
2. Vaginal swab is taken and sent for culture and
sensitivity test.
3. Blood sample is sent for ABO and cross matching
4. Antibiotic : Ceftriaxone 1g IV.
5. IV infusion, metronidazole is given for anaerobic
infection.
OBSTETRIC MANAGEMENT
 DELIVERY OF THE FETUS:
1. Vaginal delivery-
 Destructive operation in case of dead fetus.
 If the head is low down and vaginal delivery
is not risky, forceps extraction may be done

in a living baby.
 After completion of the delivery and
expulsion of the placenta, exploration of the
uterus and the genital tract should be done
to exclude uterine rupture or tear.
2. Cesarean section-
 If case is detected early with good fetal
condition, CS give the best result.
 But in case of late and neglected cases, even if
the FHS is audible, desperate attempt to do CS

to save moribound baby more often leads to
disastrous consequences.
 Over distended lower segment with the
impending rupture even the fetus is dead.
3. Symphysiotomy-
 It is a surgical procedure in which the cartilage
of the pubic symphysis is divided to widen the

pelvis allowing childbirth when there is
mechanical problem.
 Done is case of established obstruction due to
outlet contraction with vertex presentation

having good FHS.
NURSING MANAGEMENT
N URSING ASSESMENT
 Perform Leopold’s maneuvers and evaluate
fetal presentation, position and size.

 Using Friedman’s labor curve, periodically
evaluate progress of labor.

 Monitor FHR and contraction status
periodically per facility policy.
NURSING DIAGNOSIS
1. Acute pain related to physical and
psychological factors of difficult labor.
2. Fluid defecit related to increased muscular
activity without adequate fluid intake.
3. Risk for injury to mother and fetus related to
traumatic instrumental delivery and
supermoulding of fetal head.
4. Anxiety related to threat of possible operate
delivery.
RELATED RESEARCH STUDY
 TITTLE: Obstructed labor; risk factors and outcome
among women delivered in a tertiary care hospital
(May 2015).
 AUTHOR: Dr. Rahman S, Dr. Menon K.N, Dr. Usman

G.
 OBJECTIVES:
1. To asses frequency of obstructed labor among
pregnant women.
2. To determine socio-demographic risk factors
associated with obstructed labor among study
population.
3. To determine outcomes of obstructed labor
among pregnant women.
 METHOD: The study design was a hospital

based descriptive cross sectional study. The
time period was 2 months. The setting was
department of Gyne & OBG unit I,II & III of
Liquast University Hospital (LUH) , Hyderabad.
To estimate the frequency, risk factors of
outcomes of obstructed labor as of 3rd trimester
adverse pregnancy outcomes with the socio-
demographic characteristics of the pregnant
women i.e their age, residence, parity, level of
education and socio economic class
 RESULT: out of total 609 women enrolled in the
study, only 22(3.61%) were in obstructed labor.
63.4% of them were of age >30 years. More than
60% women in obstructed labor had reported
from rural areas; and >80% of them were
illiterate and belong to lower socio-economic
class. Only 4.55% of them were in obstructed
labor on 90.90% women . Not a single maternal
mortality was reported among women enrolled in
the study as obstructed labor.
 CONCLUSION: Neglected obstructed labor is a
major public health issue. It can be avoided by

addressing various socio-demographic
determinants of pregnant women.
CONCLUSION

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ASSAM OIL COLLEGE OF NURSING

PRESENTED TO: PRESENTED

 Labor is said to be obstructed where there is

enough to efface and dilate the cervix in the first

 If the head is low down and vaginal delivery

is not risky, forceps extraction may be done

the FHS is audible, desperate attempt to do CS

of the pubic symphysis is divided to widen the

outlet contraction with vertex presentation

fetal presentation, position and size.

evaluate progress of labor.

 AUTHOR: Dr. Rahman S, Dr. Menon K.N, Dr. Usman

 METHOD: The study design was a hospital

major public health issue. It can be avoided by

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