Incidence, causes and feto-maternal outcomes of obstructed labour in a tertiary health care centre

Abstract

Background: Obstructed labour is one of the most common preventable cause of maternal and neonatal morbidity and mortality in developing countries. This study was undertaken to assess the incidence, causes and feto-maternal outcomes of obstructed labour.Methods: This prospective study was carried out in the Department of Obstetrics and Gynaecology at Patna Medical College and Hospital, Patna, Bihar, India over a period of one year from February 2012 to February 2013. The 228 patients diagnosed to have obstructed labour were studied.Results: Out of 2556 deliveries conducted during this period, 228 cases of obstructed labour were found constituting an incidence of 8.9%. Majority of the patients were unbooked (89.47%), between 21-30 years of age (90.35%) and with parity 3 or more. The most common cause of obstructed labour was malposition (45.61%) followed by cephalopelvic disproportion (43.85%) and malpresentation (8.7%). caesarean section was the most common mode of delivery. In 21.92% of cases ruptured uterus was diagnosed pre-operatively among which, 2.63% has scar rupture and in remaining cases rupture was in unscarred uterus due to obstructed labour diagnosed intra-operatively. PPH was seen intra-operatively in 17.54% of cases and bladder trauma in 3.5% of cases. Most common post-operative complications were paralytic ileus (52.6%) followed by severe anaemia (48.2%) and infections (23.68%). Only 0.8% patients developed vesico-vaginal fistula as a late sequela of obstructed labour. The maternal mortality was 3.5% and perinatal mortality was 39%.Conclusions: In present study, the incidence of obstructed labour is very high. Good antenatal care, education of primary health care providers and traditional birth attendants on dangers of obstructed labour and the need for early referral is suggested to reduce the incidence of this condition.