Fetomaternal outcome in obstructed labor in a peripheral tertiary care hospital

Abstract

Background: Obstructed labor is the leading cause of hospitalization, comprising up to 39% of all obstetric patients in developing countries. It is the single most important cause of maternal death and is one of the three leading causes of perinatal mortality. Objectives: To study the different parameters of obstructed labor cases, like its frequency, etiology, management, and complications. This will help to formulate a positive strategy to prevent obstructed labor and its consequences. Materials and Methods: 313 patients admitted with features of obstructed labor were studied. By clinical examination, diagnosis of cephalopelvic disproportion, malposition, malpresentation, obstruction in birth canal, overdistended bladder, hematuria, rupture of uterus, and supermolding of fetal head was done. Screening for maternal exhaustion, dehydration, genital sepsis, pyrexia, rupture of uterus, postpartum hemorrhage, vesico-vaginal fistula, and shock was carried out. Deaths as a consequence of obstructed labor were noted. Diagnosis of asphyxiated or dead fetus or neonatal death was done. Mode of delivery and time interval between referral, admission, intervention done, and related feto-maternal outcome were noted. Statistical analysis was done using Epi Info software. Results: Majority of the patients (87.86%) were from low socioeconomic group, 88.82% were from rural areas, 16.16% were illiterate, and 27.79% were unbooked. The commonest cause of obstructed labor was cephalopelvic disproportion (55.59%). Other causes were malposition (23%), malpresentation (18.21%), fetal congenital abnormality (1.28%), myoma (0.32%), and non-dilatation of cervix (1.60%). The commonest mode of delivery was cesarean section (85.94%). Instrumental deliveries formed 9.58%. Destructive operation was done in 1.92% cases. Rupture uterus was seen in 8 (2.56%) cases, out of which hysterectomy was done in 5 cases and repair in 3 cases. The common maternal complications were sepsis [pyrexia 49.8%, urinary tract infection (UTI) 10.9%, wound infection 7.7%] and post-partum hemorrhage (PPH; 33.9%). Other complications were rupture uterus (2.56%), subinvolution (9.3%), shock (2.2%), bladder injury (1.9%), hysterectomy (1.6%), broad ligament hematoma (1.28%), maternal death (1.6%), vesico-vaginal fistula (VVF; 0.6%), and rectovaginal fistula (RVF; 0.3%). Perinatal mortality rate was 71/313 (22.68%), still birth rate was 57/313 (18.21%), and live birth rate was 256/313 (81.79%). Perinatal morbidity (in 198 cases) was most commonly due to birth asphyxia (29.68%), jaundice (16.80%), septicemia (14.84%), and meconium aspiration syndrome (9.77%). Incidence of PPH, still birth, perinatal mortality, and cesarean section was significantly higher among multiparous women. Conclusions: Cephalopelvic disproportion is the commonest cause of obstructed labor, and proper antenatal care, early diagnosis, and timely intervention may result in decrease in incidence of morbidity and mortality.

Keywords

• Maternal mortality
• obstructed labor
• perinatal mortality