![]() ![]() The labour has been prolonged (lasting more than 12 hours).Obstructed labour is more likely to occur if: Table 9.1 summarises the mechanical causes of ‘passenger’ and ‘passage’ failure.ĩ.3.1 Assessment of clinical signs of obstruction Passage: The birth canal is the passage, so labour may be prolonged if the mother’s pelvis is too small for the baby to pass through or the pelvis has an abnormal shape, or if there is a tumour or other physical obstruction in the pelvis.Prolonged labour may occur if the fetal head is too large to pass through the mother’s pelvis, or the fetal presentation is abnormal. Passenger: The fetus is the ‘passenger’ travelling down the birth canal.Either the uterine contractions are not strong enough to efface and dilate the cervix in the first stage of labour, or the muscular effort of the uterus is insufficient to push the baby down the birth canal during the second stage. Powers: Inadequate power, due to poor or uncoordinated uterine contractions, is a major cause of prolonged labour.Why labour becomes prolonged or obstructed may be due to one of the ‘Ps’ (as midwives and obstetricians call them): ‘powers’, ‘passenger’ and ‘passage’. Delayed management of obstructed labour often causes fistula in surviving women, which if not treated, may make them outcasts from their community for the rest of their lives.Īs indicated above, obstructed labour is generally a second stage phenomenon, in women whose labour is prolonged. In this session, you will learn how to identify the clinical signs of prolonged and obstructed labours and determine the best management. This shocking figure is certainly an underestimation of the problem, because deaths due to obstructed labour are often classified under other complications (such as sepsis, postpartum haemorrhage or ruptured uterus). It contributes to 22% of the maternal mortality in Ethiopia. Obstructed labour is associated with a high perinatal mortality and morbidity (fetal and newborn deaths, and disease and disability occurring around the time of the birth). It is highly prevalent in the rural areas of Ethiopia, particularly among women who are in labour at home for a long time. One of your major roles as a skilled birth attendant is to prevent the occurrence of obstructed labour in women in your community. Obstructed labour is a totally preventable labour complication.
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