In obstructed labour the membranes may rupture several hours before labour starts. The results from this study suggest that obstructed labor remains a public health problem that is still prevalent in south east nigeria. Obstructed labour, a rare event in developed countries, is a common obstetric problem ki developing countries like nigeria. Global burden of maternal death and disability british. Obstructed labor in south east nigeria revisited longdom. Delivery of the fetus at caesarean section is always difficult, especially if the fetal head is impacted in the pelvis. Prolonged labor can be determined by labor stage and whether the cervix has thinned and opened appropriately during labor.
A free powerpoint ppt presentation displayed as a flash slide show on id. After intrauterine fetal death, the head collapses, which might facilitate vaginal birth. In the last decade among the top four causes of maternal mortality, obstructed labor uterine rupture accounted for 36% of maternal mortality in ethiopia. Risk factors for ol and its associated obstetric squeal are usually context specific. This condition is rare in developed countries, but in developing countries it is a common complication of childbirth resulting from prolonged obstructed labour. View the article pdf and any associated supplements and figures for.
Vesicovaginal fistula is a devastating injury in which an abnormal opening forms between a womans bladder and vagina, resulting in urinary incontinence. The need for revival of symphysiotomy in nigeria emmanuel monjok 1, 2, 6, ita b. Fetomaternal outcome in obstructed labor in a peripheral. The prevention of obstructed labour can be promoted by. Jan 18, 20 globally, there was an estimated number of 287,000 maternal deaths in 2010. If your baby is not born after approximately 20 hours of regular. Jul 19, 2012 obstructed labour means that, in spite of strong contractions of the uterus, the fetus cannot descend through the pelvis because there is an insurmountable barrier preventing its descent. The mode of delivery at caesarean section may occasionally compound the morbidity associated with obstructed labour. Though obstructed labour is eradicated or banished from developed countries, in nigeria like most developing countries, obstructed labour with a dead foetus is a reality and a well known cause of. Neglected obstructed labour ol is a major cause of both maternal and newborn morbidity and mortality.
It remains one of the leading causes of maternal death in the country. A possible cause of obstructed labour is if the mother has a tumor growth or swelling of soft tissue in her pelvic cavity. Perinatal mortality related to obstructed labour ranges 3. Dec 25, 2018 the six main causes of maternal deaths were bleeding, sepsis, obstructed labour, ectopic pregnancy, eclampsia and unsafe abortion. Obstructed labour is still a major cause of maternal mortality and morbidity and of adverse perinatal outcome in. Prevalence, risk factors, and outcomes of obstructed labor. The pattern of obstructed labour among parturients in a. Second, although the figures given in ijaiya and aboyejis study differ slightly from those of other publications, their study does reconfirm the trends in aetiology and epidemiology of obstetric.
To study the different parameters of obstructed labor cases, like its frequency, etiology, management, and. A hole between the birth canal and bladder andor rectum, it is caused by prolonged, obstructed labour without access to timely, highquality medical treatment. Omoruyi 2008 estimated that in nigeria, more than 70 percent of maternal deaths could be attributed to five major complications. In a study from nigeria of pregnancies in which vesicovaginal fistula occurred, 917% of neonates were stillborn. This study evaluated the impact of a criteriabased audit of the diagnosis and management of obstructed labour in a lowresource setting. Nonfistulous complications of prolonged obstructed labour among obstetric fistula patients in southern nigeria.
The number of maternal deaths as a result of obstructed labour andor rupture of the uterus varies between 4% and 70% of all maternal deaths, amounting to a maternal mortality rate as high as 410100,000 live births 5. The obstructed labor complex was characterized by arrowsmith, hamlin, and wall in 1996. Incidence and management of obstructed labour in eastern nigeria. Ladipo department of obstetrics and gynaecology, university college hospital, lbadan nigeria received december 2nd, 1991 revised and accepted april 1st, 1992 abstract over a period of years, 380 cases of obstructed labor. Nonfistulous complications of prolonged obstructed labour. Obstructed labour is a common obstetric complication in nigeria associated with poor fetal and maternal outcome. Objective in lowresource settings, obstructed labour is strongly associated with severe maternal morbidity and intrapartum asphyxia, and consequently maternal and perinatal deaths. Obstructed labor is the leading cause of hospitalization, comprising up to 39% of all obstetric patients in developing countries. Obstructed labour ranked 41st in gbd 1990, representing 0. Department of obstetrics and gynaecology, university of nigeria teaching hospital, enugu, nigeria. The changing pattern of obstructed labour in lagos nigerian.
Check the fetal heart rate every halfhour at minimum when oxytocin is being infused. Causes of maternal deaths in northern nigeria research cyber. Over a five year period 19851989 527 cases of obstructed labour were recorded while 11,299 deliveries were conducted giving an incidence of 4. Complications observed in women with obstructed labor at studied areas were puerperal sepsis in 57% of cases in nigeria to 12. Prevalence, risk factors, and outcomes of obstructed labor at. An obstetric labor complication is a difficulty or abnormality that arises during the process of labor or delivery the trust for americas health reports that as of 2011, about one third of american births have some complications. Corroborating this view is bello 1996 who through her study reported that obstructed labour, accidental surgical injury related to pregnancy, and crude attempt at induced abortion influence the incidence of vesico vaginal fistula. Eighty five percent 245,000 of these deaths occurred in subsaharan africa and southern asia. Delivery of the impacted head of the fetus at caesarean. Knowledge and utilization of partograph among obstetric care. Obstructed labour british medical bulletin oxford academic.
Definition obstructed labour is the failure of the fetus to descend through the birth canal, because there is an impossible barrier preventing its descent, despite strong uterine contractions. The commonest cause was cephalopelvic disproportion 75. It leaves women leaking urine, faeces or both, and often leads to chronic medical problems, depression, social isolation and deepening poverty. Ppt obstructed labour powerpoint presentation free to. Bimbola kemi odu faculty of education, ekiti state university adoekiti, nigeria abstract this paper examined obstructed labour as a major aetiological factor causing vesicovaginal fistula among women. In terms of prevalence, it has been estimated that there are up to 800,000 women in nigeria who have a urogenital fistula from obstructed labour. Incidence and management of obstructed labour in eastern. Apr 28, 2019 in africa the prevalence of obstructed labor varies from one country to another,from the case study from nigeria the prevalence of obstructed labor ranges between 0. There is thus the need to focus on prevention of maternal deaths in nigeria by tackling these problems affecting the ability of pregnant women to access timely and quality maternal health services 1416. Obstructed labour, causes, complications ask a gynecologist. The study was a retrospective descriptive one carried out at the obstetric unit of obstetrics, gynaecology and perinatology department of ekiti state university teaching hospital eksuth, adoekiti from 1st of. Obstructed labour is the failure of the fetus to descend through the birth canal, because there is an impossible barrier obstruction preventing its descent despite strong uterine contractions.
Obstructed labour is therefore a significant cause of maternal morbidity in nigeria and many other resources. Managing prolonged and obstructed labour asma ali, bonventure ameyo masakhwe kenyauniversity of parma, italy ali a, masakhwe ba. The highest frequency was found among unbooked primigravid teenagers, who lack western education. Nigeria eastern nigeria population based 19851989 11,299 deliveries cephalopelvic disproportion 4. Prevalence, risk factors, and outcomes of obstructed labor at the. This study aimed to determine the prevalence, causes, risk factors, and outcome of. The aim of this study was to determine magnitude of obstructed labor. Obstructed labor is one of the common preventable causes of maternal and perinatal morbidity and mortality in developing countries.
Obstetric fistula is one of the most serious and tragic childbirth injuries. Among the causes of these deaths were obstructed and prolonged labour which could be prevented by cost effective and affordable health interventions like the use of the partograph. Ladipo department of obstetrics and gynaecology, university college hospital, lbadan nigeria received december 2nd, 1991 revised and accepted april 1st, 1992 abstract over a period of years, 380 cases of obstructed labor were managed. Risk factors for obstructed labour in eastern uganda.
One of your major roles as a skilled birth attendant is to prevent the occurrence of obstructed labour in women in your community. No epidemiological study has documented the risk factors for ol in eastern uganda. Training course in sexual and reproductive health research 2010. The obstruction can only be alleviated by means of an operative delivery. Obstructed labour comprises one of the five major causes of maternal mortality and morbidity in developing countries 3, 4. All cases of obstructed labor delivered by cesarean section 100%. Knowledge and utilization of partograph among obstetric. The majority of the patients 59% were primigravidae. Obstetric vesicovaginal fistula as an international public. Obstructed labour, cephalopelvic disproportion, symphysiotomy, resourcepoor communities, nigeria. On the basis of this, the module explains what makes obstructed labour more likely to occur, what happens in obstructed labour, how signs of obstructed labour can be identified, and steps to be taken for effective management. Complications for the baby include not getting enough oxygen which may result in death.
Also, poor access to and utilization of quality reproductive health services contribute significantly to the. There was a progressive decline in the time trend over the study period. It increases the risk of the mother getting an infection, having uterine rupture, or having postpartum bleeding. Introduction obstructed labour ol is an important clinical and public health problem because of the associated maternal and perinatal morbidity and mortality.
Obstructed labor is a common complication of human childbirth. This study was conducted to identify the risk factors for ol in. This study aims to determine the pattern of obstructed labour in our environment as well as examine its contribution to perinatal and maternal morbidity and mortality. Obstructed labour is an obstetric entity which is almost never seen in the developed world but remains very prevalent in the developing world. Incidence in the developing countries, the prevalence is about 12% in the referral hospitals 4.
Who midwifery education module 3 managing prolonged and. India, nigeria, ghana, ethiopia and bangladesh indicate that up to 5% of cases of uterine rupture are seen with unscarred uterus and obstructed labour is one of the top 5 causes of maternal mortality. This is similar to what has been reported from other parts of subsaharan africa, although the order of frequency may vary. Obstructed labour is a totally preventable labour complication. Obstructed labour, also known as labour dystocia, is when the baby does not exit the pelvis during childbirth due to being physically blocked, despite the uterus contracting normally. This study aimed to determine the prevalence, causes, risk factors, and outcome of obstructed labor at the university of maiduguri teaching hospital umth. Estimates suggest that at least 3 million women in poor countries have unrepaired. Complications observed in women with obstructed labour at studied areas were puerperal sepsis in 57% cases in nigeria, 12. Incidence, causes and outcome of obstructed labor in jimma. Open access research article prevalence and associated. The incidence of obstructed labour was much higher for the unbooked patients 33 % than for the booked patients 1. The study aimed to determine the prevalence, sociodemographic and clinical correlates of obstructed labour in the institution of study.
Cephalopeivic disproportion was the greatest cause of obstructed labour 67%, while caesarean section was the main method of delivery 85%. Apr 03, 2017 a possible cause of obstructed labour is if the mother has a tumor growth or swelling of soft tissue in her pelvic cavity. It is the single most important cause of maternal death and is one of the three leading causes of perinatal mortality. It can be a lifesaving procedure for both mother and baby in obstructed labour, especially in rural areas and.
Obstructed labour a series of 320 cases occurring in 4 years in a hospital in southern nigeria. Essential antenatal, perinatal and postpartum care. The prevalence of obstructed labour in aminu kano teaching hospital akth was 0. Women who survive the ordeal of prolonged obstructed labor. The most frequent cause of obstructed labour is cephalopelvic disproportiona mismatch between the fetal head and the mothers pelvic brim. Obstetric fistula unfpa united nations population fund. It is described as, the injuries resulting from prolonged obstructed labor, representing a syndrome that. A study conducted in university of ilorin, nigeria, by aboyeji et al. Essential antenatal, perinatal and postpartum care 2 required resources and visual aids the handouts required to accompany sessions have been included with each module. Obstruction usually occurs at the pelvic brim, but occasionally it may occur in the cavity or at the outlet of the pelvis. Global burden of obstructed labour in the year 2000. The characteristics of the women managed for obstructed labour in this study is similar to previous reports from nigeria and sub saharan africa 3,6.
This paper examined obstructed labour as a major aetiological factor causing vesicovaginal fistula among women. The obstruction usually occurs at the pelvic brim, but occasionally it may occur in the pelvic cavity or at the outlet of the pelvis. Obstructed labour in enugu, nigeria request pdf researchgate. The united nations population fund unfpa estimates that there are about 2 million women living with vvf, most of them in subsaharan africa 10. Globally, there was an estimated number of 287,000 maternal deaths in 2010. Women whose age ranged from 20 to 34 years were mostly. Methods a baseline criteriabased audit was conducted from october 20 to. In uganda the leading direct causes of deaths are haemorrhage 26 percent, sepsis 22 percent, obstructed labour percent, unsafe abortion 8. In parts of the world where access to emergency obstetric services is limited, obstructed labor is a major cause of maternal mortality.
Bimbola, kemi odu faculty of education ekiti state university, ado ekit nigeria abstract this paper examined obstructed labour as a major aetiological factor causing vesicovaginal fistula among women. Obstructed labour is still a common feature of our obstetric practice. Labour is considered obstructed when the presenting part of the fetus cannot progress into the birth canal, despite strong uterine contractions. The major cause of obstructed labor is cephalopelvic disproportion, which may be due to a small pelvis, a large baby, fetal malpresentation, a tight perineum, or abnormalities or tumors of the uterus, ovary, or vagina. Obstructed labour is said to result in prolonged labour, when the active phase of labour is longer than twelve hours. Obstructed labor is a common cause of fetomaternal morbidity and mortality in maiduguri, nigeria. Maternal mortality from obstructed labor ranges from 32 in nigeria to 91 in jimma university specialized hospital. This retrospective study was based on analysis of medical records. Public health strategies to prevent maternal mortality in nigeria.