Obstructed labour

Obstructed labour

Also known as labour dystocia, obstructed labour occurs when, despite adequate uterine contractions, the baby does not descend through the pelvis because of a physical obstruction. Common causes include a large baby, a narrow maternal pelvis, malpresentation, and malposition.

Clinical presentation

• Prolonged labour (>8 hours of active labour)

• Delayed second stage of labour (>1 hour)

• Fetal distress

• Severe moulding (3+)

• Severe caput succedaneum

• Maternal dehydration (neglected obstructed labour)

• Bandl's ring (a sign of neglected obstructed labour)

Management of obstructed labour at BEmONC facilities

• Insert an IV line and start infusion of 2 L of Ringer's lactate or dextrose normal saline

• Insert a urethral catheter

• Check haemoglobin level

• Encourage the patient to lie in the left lateral position

Management of obstructed labour at CEmONC facilities

• Optimize hydration with 2 L of Ringer's lactate or normal saline before caesarean section

• Ensure the patient is catheterized

• Perform haemoglobin estimation

• Perform emergency caesarean section

Pharmacological treatment

• Compound sodium lactate (IV) or 0.9% sodium chloride (IV) to ensure adequate hydration

OR

• Ampicillin (IV) 2 g within 30 minutes before caesarean section, then continue 2 g every 24 hours for 3 days

OR

• Ceftriaxone (IV) 1 g stat within 30 minutes before caesarean section, then continue 1 g every 24 hours for 3 days

OR

• Amoxicillin + clavulanic acid (FDC) (IV) 1.2 g within 30 minutes before caesarean section, then continue 1.2 g every 8 hours for 3 days

AND

• Metronidazole (IV) 500 mg within 30 minutes before caesarean section, then continue 500 mg every 8 hours for 3 days.