Obstructed labour

Source: Wikipedia, the free encyclopedia.
Obstructed labour
Other namesLabour dystocia
Frequency6.5 million (2015)[5]
Deaths23,100 (2015)[6]

Obstructed labour, also known as labour dystocia, is the baby not exiting the pelvis because it is physically blocked during

prolonged labour, when the active phase of labour is longer than 12 hours.[2]

The main causes of obstructed labour include a large or abnormally positioned baby, a small

partograph is often used to track labour progression and diagnose problems.[1] This combined with physical examination may identify obstructed labour.[7]

The treatment of obstructed labour may require

Cause

The main causes of obstructed labour include a large or abnormally positioned baby, a small

All of these factors lead to a failure in the progress of labor.

Evolution

Obstructed labor is more common in humans than any other species and continues to be a main cause of birth complications today.[12] Modern humans have morphologically evolved to survive as bipeds, however, bipedalism has resulted in skeletal changes that have consequently narrowed the pelvis and the birth canal.[13] The combination of increased brain size and changes in pelvic structure are the major contributors of obstructed labor in modern humans. It is also common for obstructed labor in humans to be caused by the fetus' broad shoulders. However, morphological shifts in pelvic structure still account for the inability of a fetus to effectively pass through the birth canal without major complications [14]

Other primates have a wider and straighter birth canal that allows a fetus to pass through more effectively.[15] Mismatch between birth canal size and infant cranial width and length due to bipedal locomotion requirements have often been referred to as the obstetric dilemma, since compared to other great apes, modern humans have the greatest disproportion between infant cranial size and birth canal size.[16] Shrinking of upper extremities and curvature of the spine have also affected the way modern humans give birth. Quadruped apes have longer upper limbs that allow them to reach down and pull their fetus out of the birth canal unassisted.[14] Other primates also have a wider and straighter birth canal that allows a fetus to pass through more effectively.[15] Modern human's shorter upper extremities and evolution of bipedal locomotion may have placed a premium on assistance during labor. For this reason, researchers argue that assisted labor may have evolved with bipedalism.[14] Obstructed labor has been documented as a complication of childbirth since the field of obstetrics originated. For over 1,000 years obstetricians have had to forcibly remove obstructed labor fetuses to prevent the death of the mother.[17]

Prior to the existence of the cesarean section, fetuses that were obstructed had a low survival rate.[17] Even in the 21st century, if obstructed labor is left untreated, it could result in mother and infant death.[16] Although surgical removal of the fetus is the preferred method of managing obstructed labor, manual removal using medical tools is also common.[15]

Diagnosis

Obstructed labour is usually diagnosed based on physical examination.[7] Ultrasound can be used to predict malpresentation of the fetus.[11] In examination of the cervix once labor has begun, all examinations are compared to regular cervical assessments. The comparison between the average cervical assessment and the current state of the mother allows for a diagnosis of obstructed labor.[1] An increasingly long time in labor also indicates a mechanical issue that is preventing the fetus from exiting the womb.[1]

Prevention

Access to proper health services can reduce the prevalence of obstructed labor.[11] Less developed areas have inadequate health services to attend to obstructed labor, resulting in a higher prevalence among less developed areas. Improving nutrition of female, both before and during pregnancy, is important for reducing the risk of obstructive labor.[11] Creating education programs about reproduction and increasing access to reproductive services such as contraception and family planning in developing areas can also reduce the prevalence of obstructed labor.[18]

Treatment

Before considering surgical options, changing the posture of the mother during labor can help to progress labor.

cesarean section or vacuum extraction with possible surgical opening of the symphysis pubis.[4] Caesarean section is an invasive method but is often the only method that will save the lives of both the mother and the infant.[18] Symphysiotomy is the surgical opening of the symphysis pubis. This procedure can be completed more rapidly than Caesarean sections and does not require anesthesia, making it a more accessible option in places with less advanced medical technology.[18] This procedure also leaves no scars on the uterus which makes further pregnancies and births safer for the mother.[1] Another important factor in treating obstructed labor is monitoring the energy and hydration of the mother.[11] Contractions of the uterus require energy, so the longer the mother is in labor the more energy she expends. When the mother is depleted of energy, the contractions become weaker and labor will become increasingly longer.[1] Antibiotics are also an important treatment as infection is a possible result of obstructed labor.[11]

Prognosis

If

cesarean section is obtained in a timely manner, prognosis is good.[1] Prolonged obstructed labour can lead to stillbirth, obstetric fistula, and maternal death.[19] Fetal death can be caused by asphyxia.[1] Obstructed labor is the leading cause of uterine rupture worldwide.[1] Maternal death can result from uterine rupture, complications during caesarean section, or sepsis.[18]

Epidemiology

In 2013 it resulted in 19,000 maternal deaths down from 29,000 deaths in 1990.[9] Globally, obstructed labor accounts for 8% of maternal deaths.[20]

Etymology

The word dystocia means 'difficult labour'.

romanized: tókos, lit.
'childbirth') 'easy labour'.

Other terms for obstructed labour include difficult labour, abnormal labour, difficult childbirth, abnormal childbirth, and dysfunctional labour.[citation needed]

Other animals

The term can also be used in the context of various animals. Dystocia pertaining to birds and reptiles is also called egg binding.[citation needed]

In part due to extensive selective breeding, miniature horse mares experience dystocias more frequently than other breeds.[citation needed]

Most

brachycephalic dogs require caesarean sections to decrease risk of mortality for both the bitch and puppies.[21] In the Boston Terrier, French Bulldog, and the Bulldog more than 80% of births require caesarean sections.[22]

  • Assisted delivery: miniature horse dystocia. Note the position of the head.
    Assisted delivery: miniature horse dystocia. Note the position of the head.
  • Miniature horse dystocia. Note the position of the head.
    Miniature horse dystocia. Note the position of the head.

References

Further reading