INTRODUCTION

As a part my Class room teaching presentation, I got a topic from Obstetrics and
Gynaecological Nursing –II specialty; in that I got a topic “OBSTRUCTED LABOR”.
So, I want to take the class about this topic to my dear IV year B Sc nursing students and
I want give more information regarding the topic.
 BACK GROUND INFORMATION:

Name of the student: Mr. Ajay D

Class/ Year: II Year M Sc Nursing
Subject: Obstetrics and Gynaecological Nursing-II
Topic: Obstructed Labor
Group: IV year B Sc Nursing
Venue: IV year B Sc Nursing class room
Time: 60 minutes
Date of teaching:15/09/2024
Methods of teaching: Teaching cum discussion and demonstration
AV Aids: Black board, leaflets, pamphlets and chart.
Previous knowledge
level of the students: Students have the less knowledge about the topic
 GENERAL OBJECTIVES:

By the end of the class room presentation; students will gain and improve their knowledge
regarding the topic of “OBSTRUCTED LABOR”.

SPECIFIC OBJECTIVES:
By the end of the class room presentation; the students will be able to:
 Define obstructed labor.
 Explain the incidence and causes of obstructed labor.
 Describe the morbid anatomical changes.
 Explain the effects of obstructed labor.
 Explain the clinical features of obstructed labor.
 Describe the prevention of obstructed labor.
 Explain the treatment of obstructed labor.
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1 2 min Self SELF INTRODUCTION :- L P Students know
Introduction myself
I am Mr. Ajay D, from II year
P
M.Sc Nursing Student {Obstetrics and I

Gynaecological Nursing}. As a part of T

my Class room presentation. I got a topic S

from Obstetrics and Gynaecological

Nursing –II Speciality; the topic is T

“OBSTRUCTED LABOR”. So, I want

to take class room presentation of this E

topic to 4th year B sc Nursing students.

N

G
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2 2 Define DEFINITION: D LI L Students
minutes obstructed Obstructed labor is one where in spite of good I E understand the
ST
labor F A definition
uterine contractions; the progressive descent of the
EN F
presenting part is arrested due to mechanical I
L
obstruction. This may result either due to factors in N IN
E
the fetus or in the birth canal or both, so that further I G T
progress is almost impossible without assistance. NG
3 5 Explain the INCIDENCE: In the developing countries, the E L P Students
minutes incidence and prevalence is about 1–2% in the referral hospitals. understand the
X I P incidence and
causes of
CAUSES: causes of
P S T
obstructed obstructed labor
 Fault in the passage:
labor  Bony: Cephalopelvic disproportion and L T
contracted pelvis are the common causes.
Secondary contracted pelvis may be A E &
encountered in multiparous women.
I N
 Soft tissue obstructions: This includes
cervical dystocia due to prolapse or N I C
previous operative scarring, cervical or
broad ligament fibroid, impacted ovarian I N H
tumor or the nongravid horn of a bicornuate
N G A
uterus below the presenting part.
 Fault in the passenger: G R
 Transverse lie,
 Brow presentation, T
 Congenital malformations of the fetus—
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hydrocephalus (commonest), fetal ascites,
double monsters,
 Big baby, occipitoposterior position,
 Compound presentation,
 Locked twins.
4 5 Describe the MORBID ANATOMICAL CHANGES: D L P Students
minutes morbid  UTERUS: The morbid anatomical changes in understand the
anatomical response to obstruction have already been E I P morbid
changes described in relation to the formation of anatomical
pathological retraction ring or Bandl’s ring. S S T changes.
 BLADDER: The bladder becomes an
abdominal organ and due to compression of C T
urethra between the presenting part and
symphysis pubis, the patient fails to empty the
R E
bladder. The transverse depression at the
junction of the superior border of the bladder
and the distended lower segment is often I N
confused with the Bandl’s ring. The bladder
walls get traumatized, which may lead to blood B I
stained urine, a common finding in obstructed
labor. The base of the bladder and urethra, I N
which are nipped in between the presenting part
and symphysis pubis, may undergo pressure N G
necrosis. The devitalized tissue becomes
infected and later on may slough off resulting
G
in the development of genitourinary fistula.

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5 8 Explain the EFFECTS ON THE MOTHER: E L P Students
minutes effects of Immediate: understand the
obstructed X I P effects of
 Exhaustion is due to a constant agonizing pain
labor. and anxiety. obstructed labor
  Dehydration is due to increased muscular P S T
activity without adequate fluid intake.
 Metabolic acidosis is due to accumulation of L T
lactic acid and ketones.
A E &
 Genital sepsis is an invariable accompaniment,
especially after rupture of the membranes with I N
repeated vaginal examination or attempted
manipulation outside. N I P
 Injury to the genital tract includes rupture of
the uterus which may be spontaneous in I N A
multiparae or may be traumatic following
N G M
instrumental delivery.
 Postpartum hemorrhage and shock may be G P
due to isolated or combined effects of atonic
uterus or genital tract trauma. All these lead to H
an increased maternal morbidity and mortality.
The deaths are due to rupture of the uterus, L
shock and sepsis with metabolic changes.
E
Remote: Even if the patient survives, the following
legacies may be left behind: T
 Genitourinary fistula or rectovaginal fistula,
 Variable degree of vaginal atresia,
 Secondary amenorrhea following
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hysterectomy due to rupture or due to E L P Students
Sheehan’s syndrome. X I P understand the
P S T effects of
 EFFECTS ON THE FETUS: L T obstructed labor
 Asphyxia results from tonic uterine contraction A E &
that interferes with the uteroplacental I N
circulation or due to cord prolapse, especially N I P
in shoulder presentation. I N A
 Acidosis due to fetal hypoxia and maternal N G M
acidosis. G P
 Intracranial hemorrhage is due to H
supermoulding of the head leading to tentorial L
tear or due to traumatic delivery. E
 Infection. All these lead to increased perinatal T
loss.
6 5 Explain the CLINICAL FEATURES: E L P Students
minutes clinical  The patient is in prolonged labor having severe X I P understand the
manifestations and continuous pain. P S T clinical
of obstructed  Abdominal examination reveals the uterus to be L T manifestations
labor somewhat smaller in size, tense and tender. A E of obstructed
 Fetal parts are neither well defined, nor is the I N labor
fetal heart sound audible. N I
 Vaginal examination reveals jammed head with I N
big caput, dry and edematous vagina. N G
G

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7 5 Describe the PREVENTION: D L P Students
minutes prevention of  Antenatal detection of the factors likely to E I P understand the
obstructed produce prolonged labor (big baby, small S S T prevention of
labor women, malpresentation and position). C T obstructed labor
 Intranatal Continuous vigilance, use of R E
partograph and timely intervention of a I N
prolonged labor due to mechanical factors can B I
prevent obstructed labor. Failure in progress of I N
labor in spite of good uterine contractions for a N G
reasonable period (2–4 hours) is an impending
G
sign of obstructed labor.
8 20 Explain the TREATMENT: E L P Students
minutes treatment of PRINCIPLES: understand the
obstructed X I P treatment of
labor.
 To relieve the obstruction at the earliest by a
safe delivery procedure, obstructed labor
P S T
 To combat dehydration and ketoacidosis,
 To control sepsis. L T

PRELIMINARIES: A E
1. Fluid electrolyte balance and correction of
I N
dehydration and ketoacidosis are done by rapid
infusion of Ringer’s solution; at least 1 liter is N I
to be given in running drip. At least 3 liters of
fluid is required to correct clinical dehydration. I N
2. A vaginal swab is taken and sent for culture and
sensitivity test. NG G

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 3. Blood sample is sent for group and cross E L P Students
matching and a bottle of blood should be at hand understand the
prior to any operative intervention. treatment of
X I P
4. Antibiotic: ceftriaxone 1 g IV is administered. obstructed labor
5. IV infusion, metronidazole is given for
anaerobic infection. P S T

OBSTETRIC MANAGEMENT:
Before proceeding for definitive operative L T
treatment, rupture of the uterus must be excluded. A
balanced decision should be taken about the best
A E
method of relieving the obstruction with least
hazards to the mother. Frantic attempt to deliver a
moribund baby by a method ignoring the risk I N
involved to the mother is indeed bad obstetrics.
There is no place of “wait and watch”, neither is any
scope of using oxytocin to stimulate uterine N I
contraction.
I N
VAGINAL DELIVERY:
The baby is invariably dead in most of the
neglected cases and destructive operation is the best N G
choice to relieve the obstruction. If, however, the
head is low down and vaginal delivery is not risky,
G
forceps extraction may be done in a living baby.
There is no place of internal version in obstructed

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labor. After completion of the delivery and E L P Students
expulsion of the placenta, exploration of the uterus understand the
and the lower genital tract should be done to treatment of
X I P
exclude uterine rupture or tear. obstructed labor

CESAREAN SECTION: P S T
If the case is detected early with good fetal
condition, cesarean section gives the best result. But
in late and neglected cases, even if the fetal heart L T
sound is audible, desperate attempt to do a cesarean
section to save the moribund baby more often leads
A E
to disastrous consequences. Not infrequently, the
baby is either delivered stillborn or dies due to
neonatal sepsis. The postoperative period of the I N
mother also becomes stormy and at times, ends
fatally.
N I
SYMPHYSIOTOMY:
The place of symphysiotomy has to be duly I N
considered in the developing countries as an
alternative to risky cesarean section. This can be
done in a case of established obstruction due to N G
outlet contraction with vertex presentation having
good FHS.
G

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7 2 Summary SUMMARY: L F Student
minute Today we have discussed obstructed labor in that, understand the
s I L summary
definition, incidence, causes, morbid anatomy,
effects, clinical manifestations, prevention and S A
treatment of obstructed labor.
8 3 Conclusion CONCLUSION: T S Student
minute  Obstructed labour, also known as labour understand the
s E H conclusion of
dystocia, is the baby not exiting the pelvis
because it is physically blocked during childbirth version
N
although the uterus contracts normally.
Complications for the baby include not getting I C
enough oxygen which may result in death.
N A

G R
9 3 Bibliography BIBLIOGRAPHY Student clear
D
minute 1. Dutta D C, “TEXTBOOK OF OBSTETRICS”, about books for
s 8th edition, Jaypee Brothers publication, New reference
Delhi. Page No: 467-468
2. Kour Sandeep, TEXTBOOK OF MIDWIFERY
AND OBSTETRICAL NURSING, CBS
Publication, 1st edition, 2020-21, New Delhi,
Page No: 442-444