Obstructed Labour

Obstructed Labour - An Avoidable Tragedy PROF. SURENDRA NATH PANDA, M.S. & DR. ANITA LENKA, M.B.B.S. Postgraduate

Dept. of Obstetrics and Gynaecology M.K.C.G. Medical College Hospital

Berhampur, Orissa, INDIA

INTRODUCTION Even in the 21st century, obstructed labour still remains a lifethreatening 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. July 13, 2009

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

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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.

July 13, 2009

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

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MAGNITUDE OF OBSTRUCTED LABOUR IN OUR HOSPITAL EVENTS During 10/99 –12/01

TOTAL OBSTRUCTED LABOUR NO. NO (%)

DELIVERIES

4107

256

(06.23)

CAESAREAN SECTION

1595

213

(13.35)

131

NIL

NIL

RUPTURE UTERUS

37

26

(70.27)

OBST. HYSTERECTOMY

34

22

(64.71)

DESTRUCTIVE OPERATION

17

17

(100.00)

MATERNAL DEATH

98

04

(04.08)

LIVE BIRTH

3778

190

(05.03)

STILL BIRTH

340

67

(19.71)

NEONATAL DEATH

324

24

(07.41)

INSTRU. DELIV.

July 13, 2009

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

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AGE AND PARITY OF PATIENTS Parity > Age in Yrs.

0

1

2

3

4+

Total No. ( %)

<20

59

08

00

00

00

67 (26.17)

21-25

68

30

05

05

04

112 (43.75)

26-30

20

17

06

13

07

63 (24.61)

31-35

03

01

00

00

06

10 (03.91)

>35

00

00

02

00

02

04 (01.56)

Total (%)

July 13, 2009

150 56 (58.59) (21.88)

13 18 19 256 (5.08) (7.03) (7.42)

(100)

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

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DEMOGRAPHIC PROFILE CHARACTERISTICS RESIDENCE Rural Urban LITERACY Illiterate Literate SOCIO-ECONOMIC STATUS Lower Middle A.N.C Unbooked Booked July 13, 2009

NO

( %)

220 (85.94) 36 (14.06) 220 (87.94) 31 (12.11) 226 (88.28) 30 (11.72) 234 (91.41) 22 (08.56)

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

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MATERNAL CONDITION AT ADMISSION Condition At Admission A-Minimal Obstruction, maternal

Number

(%)

67

26.17

32

12.50

139

54.30

18

07.03

256

100

condition Good

B-Moderate Obstruction, maternal condition Good

C-Mod / Severe Obstruction, maternal condition Bad

D-Rupture Uterus Total July 13, 2009

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

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DURATION OF LABOUR AND RUPTURE OF MEMBRANE AT ADMISSION Dur. in Hrs

Labour NO. (%)

12 or less

37

(14.45)

124 (59.05)

13-18

69

(26.96)

53 (25.23)

19-24

70

(27.34)

26

(8.09)

25 or more

80

(31.25)

53

(7.62)

Total July 13, 2009

256

Rupt.of Memb. NO. (%)

256

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

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CAUSES OF OBSTRUCTED LABOUR Cause

No. (%) Cause

CPD

140 (54.69) TWIN Locked ------1 Conjoined---1

No, (%) 2 (0.95)

DTA

45 (17.58) BROW

1 (0.47)

TRANS. LIE

33 (12.89) HYDROCEP.

1 (0.47)

OCC.POST.

17

(6.64) COMP.PRES.

1 (0.47)

NON DILA. OF CX.

9

(3.52) FOE. ASCITES

1 (0.47)

BREECH

3

(1.17) CX. FIBROID

1 (0.47)

FACE (Mento-Posterior)

2

(0.78)

July 13, 2009

TOTAL

256

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

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MODE OF DELIVERY CAESAREAN SECTION   

Live Births Still Births Neonatal Death

213* 83.20% 190+ 24+ 24

DESTRUCTIVE OPERATIONS  

Craniotomy Evisceration



Hysterectomy Repair

TOTAL

06.64%

26

10.16%

06 08

RUPTURED UTERUS 

17

22 04

256

*One patient underwent hysterectomy on 9th day for infection & gangrene +Includes one twin delivery of live & still birth July 13, 2009

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

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MATERNAL MORBIDITY AND MORTALITY MORBIDITY

No.

Pyrexia

(%) MORBIDITY

128 (50.00) Broad Ligament Haematoma

No.

(%)

12

(4.69) (2.34)

P.P.H

85 (33.20) Pritonitis

6

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

3 (1.42)

Sub involution

24 (9.77) V.V.F.

Thrombophleb. No.Of Morbid Pts. July 13, 2009

14 1

(5.71)

Burst abdomen

(88.28) DEATHS

2

(0.78

1 (1.42) 4 (1.42 )

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

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NEONATAL MORBIDITY AND MORTALITY IN 161 LIVE BIRTHS MORBIDITY

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

0

12

(6.32)

0

Diarrhoea

4

(2.48)

0

Facial Injury

3 (1.580

Cephlohaematoma

2 (1.05)

NEONATES WITH MORBIDITY July 13, 2009

156 (82.11)

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

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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 July 13, 2009

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

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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

July 13, 2009

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

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LET US MAKE MOTHERHOOD SAFE

This Paper was presented at the 45th All India Obstetric and Gynaecological Congress at Bhubaneswar on 07-01-2002 July 13, 2009

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

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