Obstructed Labor

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Also known as labour dystocia, is when despite adequate uterine contractions the baby does not exit  the  pelvis  during  due  to  being  physically  blocked.  Obstructed  may  commonly  be  caused  by;  big  baby, narrow maternal pelvis, malpresentation and malpositions. 

Clinical presentations 

  • Prolonged labour (˃8hours of active labour)
  • Delayed  second  stage  of  labour (˃1hour)
  • Fetal distress
  • Severe moulding (3+)

Management of obstructed labour at B-EMONC facilities 

  • Insert IV line with and start RL/ DNS infusion 2L
  • Insert urethral catheter
  • Check Hb
  • Encourage the patient to lay in left lateral position 

Management of Obstructed labour at the C-EMONC facilities 

  • Optimize hydration by RL/NS 2lt before caesarean section 
  • Ensure the patient is catheterized,  
  • Perform Hb estimation 
  • Perform emergency caesarean section. 

Pharmacological treatment 

A: compound sodium lactate (IV)/sodium chloride (IV) 0.9%to ensure adequate hydration 

OR 

A: ampicillin (IV) 2g within 30m before CS, continue 2g 24hourly for 3days 

OR 

B: ceftriaxone (IV) 1g stat within 30min before CS, continue 1 g 24hourly for 3days 

OR 

C:  amoxycillin  +  Clavulinic  acid  (FDC)  (IV)  1.2g  within  30min  before  CS,  continue  1.2g 8hourly for 3days 

AND 

B: metronidazole (IV) 500mg within 30min before CS, continue 500mg 8hourly for 3days.