Obstetrics Simplified - Diaa
It is the arrest of vaginal delivery of the foetus due to mechanical obstruction.
- Bony obstruction: e.g.
- Contracted pelvis.
- Tumours of pelvic bones.
- Soft tissue obstruction:
- Uterus: impacted subserous pedunculated fibroid, constriction
ring opposite the neck of the foetus.
- Cervix: cervical dystocia.
- Vagina: septa, stenosis, tumours.
- Ovaries: Impacted ovarian tumours.
- Malpresentations and malpositions: e.g.
- Persistent occipito-posterior and deep transverse arrest,
- Persistent mento-posterior and transverse arrest of the face
- Impacted frank breech.
- Large sized foetus (macrosomia).
- Congenital anomalies: e.g.
- Foetal ascitis.
- Foetal tumours.
- Locked and conjoined twins.
It is the clinical picture of obstructed labour with impending rupture
uterus (excessive uterine contraction and retraction).
- prolonged labour,
- frequent and strong uterine contractions,
- rupture membranes.
It shows signs of maternal distress as:
- high temperature (³ 38oC),
- rapid pulse,
- signs of dehydration: dry tongue and cracked lips.
- The uterus:
- is hard and tender,
- frequent strong uterine contractions with no relaxation in between
- rising retraction ring is seen and felt as an oblique groove
across the abdomen.
- The foetus:
- foetal parts cannot be felt easily.
- FHS are absent or show foetal distress due to interference with
the utero-placental blood flow.
- Vulva: is oedematous.
- Vagina: is dry and hot.
- Cervix: is fully or partially dilated, oedematous and hanging.
- The membranes: are ruptured.
- The presenting part: is high and not engaged or impacted in the
pelvis. If it is the head it shows excessive moulding and large caput.
- The cause of obstruction can be detected.
- Constriction ring.
- Full bladder.
- Fundal myoma.
- Maternal distress and ketoacidosis.
- Rupture uterus.
- Necrotic vesico-vaginal fistula.
- Infections as chorioamnionitis and puerperal sepsis.
- Postpartum haemorrhage due to injuries or uterine atony.
- Intracranial haemorrhage from excessive moulding.
- Birth injuries.
- Preventive measures:
- Careful observation, proper assessment, early detection and
management of the causes of obstruction.
- Curative measures:
- Caesarean section is the safest method even if the baby is dead
as labour must be immediately terminated and any manipulations may
lead to rupture uterus.
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Edited by Aldo Campana,