Obstructed labour in Enugu, Nigeria

Abstract

Obstructed labour is an important cause of maternal death in developing countries. Obstructed labour also causes significant maternal morbidity mainly due to infection and hemorrhage and foetal death from asphyxia is also common. Objectives are to reduce maternal and newborn complications by early detection and rapid interventions and to reduce maternal and perinatal morbidity and mortality. This Hospital-based prospective cross-sectional study was conducted from June 2013 to June 2014 in Sylhet, MAG Osmani Medical College Hospital. 100 obstructed labour cases were selected those who were admitted in Inpatient department of Obstetrics and Gynaecology, SOMCH. 100 obstructed labour cases were recorded. The majority (80%) were residents of rural areas in which transportation were difficult, the occupation of the women were housewives mostly (90%) and remaining (10%) were tea-garden worker.75% of the obstructed labour cases did not have any antenatal follow-up. Most of the cases (70%) were visited Osmani Medical College Hospital by their attendant. 70% Visited at 12-24 hours of labour, (80%) came from a distance of 10-50 kilometers. Cepholo-pelvic disproportion was the major cause of obstructed labour (78%) and cesarean section was the main way of delivery (95%). PPH (4%), puerperal sepsis (4%), rupture uterus (2%), VVF (2%), rupture uterus with shock (1%), were the main complications and maternal death (1%). Obstructed labour was the major causes of poor perinatal outcome and perinatal death (7%). This study revealed high incidence of maternal morbidity and perinatal morbidity and mortality.

Obstructed labour caused by foetal congenital hydronephrosis. Trans-abdominal drainage of the hydronephrosis with resultant delivery per vagina

“…The reported incidence of obstructed labour in this hospital was 3.2% [1] which is very much in line with reported incidences in Nigeria and other parts of the developing world [2][3][4][5][6]. Foeto-pelvic disproportion was the commonest cause in this centre and Foetal congenital anomaly as a cause of obstructed labour was only 1.5% of cases with Hydrocephalus been the commonest; but this is the first time that bilateral Hydronephrosis will be documented.…”

“…Therefore a destructive operation such as Embryotomy (Evisceration) after Decapitation and or Cleidotomy would have been treatment of choice. Caesarean Section has often been the alternative in Centres where destructive operations are not in use or of limited experience though abdominal deliveries in such cases carries higher risk of post operative wound infection as high as 34.3% [1][2][3]. However, destructive operations poses a substantial risk to the Mother in terms of Genital Tract lacerations or injuries to surrounding structures such as bladder or lower gastro intestinal tract [1][2][3][4][5][6].…”

“…The commonest treatment option for obstructed labour is Caesarean Section especially when the Foetus is alive, but is associated with a high post operative infection rate [1][2][3]. Destructive Operation such as decapitation, Cleidotomy with or without Embryotomy (Evisceration) when the Foetus is dead carries with it risk of maternal genital injuries, haemaorrhage as well as infection.…”

“…The common causes of obstructed labour including contracted pelvic, uterine abnormalities, maternal pelvic tumours, fetal malpresentation, and congenital fetal abnormalities like Hydrocephalus, Polycystic Kidneys/Hydronephrosis or locked twins [1][2][3][4].…”

Magnitude of Obstructed Labor and Associated Risk Factors among Mothers Come for Delivery Service in Adama Hospital Medical College, Oromia Regional State, Central Ethiopia

“…Studies in low-income countries have reported that the prevalence of OL is between 2-8% of all institutional deliveries [12,13]. This may underestimate maternal deaths due to obstructed labor because it is rarely documented as a primary cause of death rather classified as, rather classified as sepsis, ruptured uterus or hemorrhage rather than the underlying cause [14].…”