SOCIODEMOGRAPHIC PROFILE AND CLINICAL OUTCOME OF OBSTRUCTED LABOUR

Tashaffi Qayoom and Nighat Firdous. Department of Obstetrics and Gynaecology, Government Medical College, Srinagar, Jammu and Kashmir, India. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


ISSN: 2320-5407
Int. J. Adv. Res. 6(2), 196-201 197 Obstructed labour is defined as the condition that results from failure of descent of fetal presenting part in the birth canal despite adequate uterine contractions 1 . Additional features include prolonged labour, hypertonic uterine contractions, bandl's ring 2 (pathological retraction ring between upper and lower segment ), signs of maternal exhaustion , excessive moulding 3,4 of fetal head, caput succedaneum 5 , vulval edema and clinical signs of shock. The estimated prevalence is 1 to 2 % in developing countries. Causes include 6  Several studies have been conducted regarding obstructed labour. In majority of studies lower segment caesarean section (LSCS) was the common mode of delivery. The perioperative complications included abdominal distension, postpartum hemorrhage, perineal injuries, sepsis,uterine rupture and urinary tract injuries. It is also a significant contributor to stillbirths and neonatal mortality.
The aim of this study was to evaluate maternal and perinatal outcome in obstructed labour with an effort to determine predisposing factors.

Methodology:-
The information collected included obstetric history, sociodemographic history, medical and surgical history of the patient. General condition of the patient was noted with detailed clinical examination. Appropriate management was done and the details thereof of the mode of delivery and associated complications were noted. All patients were followed upto six weeks in postpartum period. Fetal condition was evaluated in terms of occurrence of asphyxia, number of live and stillbirths and neonatal deaths. Apgar score at 5 minutes of less than 4 was taken as birth asphyxia 7 .
198 Data Analysis:-Continuous variables were summarized as mean+ standard deviation . Categorical variables were summarized as percentages.

Results:-
About 120 cases of obstructed labour were studied. The mean age was 30.5+3.29 in years (table 1). Cephalopelvic disproportion was the most common cause in 62.5% followed by malpresenations of fetus in 30.8% and congenital fetal malformations in 6.7% (table 2). Most of the patients were primigravidas (49.2%) followed by parity more than or equal to 3 in 22.5% as shown in table 3. Majority (87.5%) were from rural areas ( There were 108 livebirths(90%) and 12 stillbirths (10%) as depicted in table 12. Neonatal asphyxia and NICU admission was seen in 34.2% livebirths and neonatal death was seen in 7.4% as shown in table 13. Majority of babies (56.5%) has 5 minute apgar score more than or equal to 7, while 34.2% had apgar score less than 4 as shown in table 14.           There were 108 livebirths (90%) as shown in table 12. Neonatal asphyxia was seen in 34.2% patients. Neonatal death was seen in 7.4% patients as depicted in table 13. As shown in table 14 majority of babies had 5 minute Apgar score more than or equal to 7.    11 who reported abdominal distension as the most common complication followed by sepsis in 14.3% and postpartum hemorrhage in 9.6% cases.
No case of vesicovaginal fistula was reported over a period of six weeks due to prophylactic bladder catheterization for 7 to 10 days in these patients.
Most patients had postpartum hospital stay of 8 to 10 days(72.5%).J Wanyoike et al ( 2015) 14 in his study reported majority of these patients with a postpartum hospital stay of 8 to 14 days(46.7%).
In our study 37 out of 108 live born babies (34.2%) had an Apgar score < 4 at 5 minutes of birth comparable to the study of Islam JA et al (2012) 11 who reported 33.3% babies with Apgar scores < 4 at 5 minutes of birth. All of these babies with neonatal asphyxia were admitted in Neonatal ICU(NICU) . Ritu Gupta et al ( 2012) 15 reported NICU admission rate of 55.7% in their study.
8 babies(7.4%) died in neonatal period comparable to the study of Anjum Ara et al(1996) 10 where 7% babies born to mothers with obstructed labour died in the neonatal period.

Conclusion:-
Obstructed labour is one of the main contributors to maternal and fetal morbidity and mortality in developing countries. Improvement in socioeconomic conditions and health education along with timely and proper intervention can help to a great extent in reducing the burden it poses on health system.

Funding:
No funding sources.