We prevent obstructed labour first by pelvic assessment.

The obstructed labour injury complex describes a spectrum of injuries that result following the aftermath of obstructed labour. Obstructed labour is a salient contributor to maternal mortality in low-resource regions like sub-Saharan Africa (Wall, 2012). Fistulas that arise among the women of childbearing age in this region are mainly due to prolonged neglected labour. As a reminder to health care professionals, let’s revisit the complications a woman can suffer when the obstruction ensues, but first, we shall define what obstructed labour is. Let’s get started.

The failure of the presenting part of the fetus to descend into the birth canal despite adequate contractions is what defines obstructed labour (Kayiga H. et al. 2016). One of the causes of prolonged labour is malalignment of the fetus with the maternal pelvis. We term it cephalo-pelvic disproportion.

5% of all pregnant women worldwide become obstructed, and it contributes approximately 8% of maternal mortality in the world. Herbert Kayiga et al. noted that the prevalence of obstructed labour in six hospitals in southwestern Uganda was 10.5% in one study. They also observed that obstructed labour contributed either directly or indirectly to 26% of maternal mortality, 40% of High Dependency Unit admissions, as well as 30% of the obstetric fistula patients managed in Mulago in 2012. So, we can visualize the catastrophic effects of obstructed labour.

Obstetric fistula results from prolonged neglected obstructed labour.
Obstetric fistula results from prolonged neglected obstructed labour.
Credit: Wikipedia

We divide the spectrum of injuries found in the obstetric labour injury complex into nine parameters for the matter of simplicity. However, these are all interrelated: no woman can suffer one single complication.

These include;
-acute obstetric injury,
-Urologic injury,
-gynecologic injury,
-gastrointestinal injury,
-musculoskeletal injury,
-neurological injury,
-dermatologic injury,
-fetal/neonatal injury,
and psychosocial injury.

It is worth noting that obstructed labour leading to such disastrous effects is a principal sign of poor obstetric care in the region.

Among the acute obstetric injuries include;
– postpartum haemorrhage due to uterine atony.
-Intrauterine infection may culminate in sepsis.
-venous thromboembolic events,
-massive vulvar oedema,
-pathological uterine retraction ring (Bandl’s) and
-rupture of the uterus.

Urologic injuries include;
– obstetric fistula,
-urethral damage with complete loss of the urethra, a possible outcome,
-bladder stone formation,
hydronephrosis
– pyelonephritis, and
-renal failure.

Gynaecologic injuries are;
-Amenorrhea,
-scarring and stenosis of the vagina with complete loss of coital function,
– cervical damage, loss of the entire cervix in the extremes of cases,
– secondary pelvic inflammatory disease and
secondary infertility.

Gastrointestinal injuries include acquired atresia of the rectum, rectovaginal fistula, faecal incontinence following damage of the anal sphincter.

Inflammation of the pubic bone (osteitis pubis), as well as other pelvic bone and floor trauma, constitute the injuries of the musculoskeletal system.

Obstetric palsy with a foot drop and neuropathic bladder dysfunction is a common neurologic sequela of obstructed labour.
There can be chronic excoriation of the woman’s skin from maceration by urine and faeces.

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Approximate 92% of perinatal mortality occurs in obstructed labour. Those neonates who survive often suffer from neonatal sepsis, birth asphyxia, injuries to the scalp, intracranial haemorrhage, and nerve palsies, among other neonatal injuries.

Many of the women who suffered from obstructed labour become socially isolated due to chronic leakage of urine and faeces. Others are divorced, become malnourished, and suffer posttraumatic stress disorder and depression, which many times culminates into suicide. Many become more impoverished than before due to the lack of both partner and community support. These are some of the psychosocial injuries.

In a nutshell, the fight to prevent obstructed labour is a collective responsibility that everyone in the society should take on. The catastrophe is an indicator of poor maternal and child health care delivery in the country. Obstetric fistula is a national disgrace and shame that leaves a stain to anyone of us who has the powers to mitigate this complication that entirely results from prolonged labour.

Join us as we discuss the prevention of obstetric fistulas in resource-limited countries by understanding the Haddon matrix in our next article.

By IAmDrSsekandi

I am a medical officer interested in maternal and child health. I am a content creator, author and founder of https://ssekandima.com. I do private practice with a public touch. I am a certified digital marketer. I earned certificates in Understanding Clinical Research and Writing in Sciences from the University of Cape Town and Stanford University respectively.

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