Factors affecting fetomaternal outcome in obstructed labor: A tertiary care centre experience in North East India

Abstract

Objective: Obstructed labor comprises one of the five major causes of maternal mortality and morbidity in developing countries. Perinatal asphyxia due to obstructed labor not only lead to neonatal deaths, also accounts for a significant proportion of stillbirths. This study has been done to assess socioeconomic factors, clinical profile and to evaluate fetomaternal outcome in obstructed labor cases from a developing country perspective. Study design: This hospital based observational study was conducted at Gauhati medical college and hospital (GMCH), Guwahati, India for one year. All the obstructed labor cases admitted during this period (1st June 2019 to 31st May 2020) were enrolled in the study and evaluated. Results: Out of total 18768 deliveries 210 cases were diagnosed as obstructed labor, incidence being 1.12%. The mean age of our study population was 22.4 ± 5.4 years. Majority patients were from rural areas (89.50%), belonged to lower middle socioeconomic class (60.9%). Unbooked cases comprised 80% of the study population. Mean duration of stay in referral center before being referred to our institution was 22.1 ± 5.6 hours. Most common cause of obstructed labor was cephalopelvic disproportion (CPD) (57.6%). Incidence of CPD was significantly higher in nulliparous cases (p value <0.0001) whereas incidence of malposition and malpresentation was significantly higher in multiparous (p value <0.0001). Sepsis was the commonest maternal complication (36.2%) and birth asphyxia was the commonest neonatal complication (44.64%). Conclusion: Lack of patient's education, inadequate antenatal care and skills in the peripheral health care setup along with poor referral facilities are responsible for most cases of obstructed labor in our study.