MOMINA KHAN

FINAL YEAR MBBS

ROLL NO: 08-103

BATCH: G

WHEN PROGRESS OF LABOUR IS COMPLETELY STOPPED DESPITE STRONG UTERINE CONTRACTIONS .

DISPROPORTION BETWEEN DIAMETER OF BIRTH CANAL AND FETUS.

CAUSES IN MOTHER:1. CONTRACTED PELVIS (DEVELOPMENTAL, METABOLIC OR

TRAUMATIC)2. PELVIC MASS

a. FIBROIDS IN LOWER UTERINE SEGMENTb. OVARIAN CYSTS IMPACTED IN POUCH OF DOUGHLASc. PELVIC KIDNEYS d. BONY TUMOURS OF PELVISe. SOFT TISSUE TUMOURS ( BLADDER, RECTUM)

3. CONGENITAL ABNORMALITIES OF UTERUS

a. OBSTRUCTION OF UTERUS LIKE EXTRA TISSUE

AT HYMEN OR ENTERENCE OF VAGINA .

b. DOUBLE UTERUS .

4.OBSTRUCTION DUE TO LOWER GENITAL TRACT CONDITIONS:

a. CERVICAL STENOSIS

b. VAGINAL STENOSIS

c. ADHESIONS ( SURGICAL)

CONTRACTED PELVIS

1. FETAL MACROSOMIA (>4Kg)

2. FETAL MALPOSITION AND MALPRESENTATION.

a. OCCIPITO POSTERIOR ( IN PRIMIGRAVIDA

COMMON).

b. MENTO POSTERIOR

c. BREECH

d. BROW

e. TRANSVERSE LIE

3. CONGENITAL ANAMOLIES:a. HYDROCEPHALY

b. FETAL HYDROPS

c. ASCITES

d. ABDOMINAL MASSES

e. CONJOINT TWINS

IN RESPONSE TO MECHANICAL OBSTTRUCTION IN PRIMIGRAVIDA THE CONTRACTILITY OF UTERUS DECREASES SO IT GOES INTO THE STATE OF UTERINE INERTIA.

MOTHER AND FETUS ARE AT THE RISK OF DEATH DUE TO SEPSIS.

BEHAVIOUR OF UTERUS IN OBSTRUCTED LABOUR IN MULTIGRAVIDA

CONTRACTIONS BECOME MORE AND MORE.

THE UPPER SEGMENT OF UTERUS BECOMES THICKER AND THICKER DUE TO CONTRACTION AND REFRACTION WHILE LOWER SEGMENT BECOMES WEAKER AND WEAKER.

THE JUNCTION BETWEEN SEGMENTS IS REPRESENTED BY A DEPRESSION CALLED AS BANDL’S RING.

CLINICAL FEATURES 1.GENERAL PHYSICAL EXAMINATION

MOTHER EXAUSTED / ANXIOUS PAINFUL STATETACHYCARDIA / FEEBLE PULSEBLOOD PRESSURE ( INCREASED, DECREASED OR NORMAL) DEHYDRATION FOUL SMELLING BREATHSCANTY CONCENTRATED URINE CONTAINING KETONE BODIES / BLOOD.

2. PER ABDOMEN EXAMINATION

INSPECTION:

TONICALLY CONTRACTED UTERUS FULL BLADDER BANDL’S RING.

PALPATION: UTERUS IS TENDER LIQUOUR ALL DRAINED FETAL PARTS DIFFICULT TO PALPATE. FETAL HEART SOUNDS ABSENT ( DIFFICULT TO AUSCULTATE / ABNORMALITIES IN FETAL HEART SOUNDS)

OEDEMA VULVADRY HOT VAGINAL MUCOSA CERVIX POORLY APPLIED TO PRESENTING PARTCERVIX LOOSELY HANGING /PARTIALLY DILATEDMECONIUM DRAININGCAPUT ON PRESENTING PARTMOULDINGIF UTERUS HAS RUPTURED FETAL PARTS WILL BE PALPABLE IN PERITONEAL CAVITY AND UTERUS IS FELT AS SEPARATE FIRM MASS.

IN FETUS: FETAL ASPHYXIA INTRACRANIAL HAEMORRHAGE PNEUMONIA DUE TO ASCENDING INFECTION FETAL DEATH

IN MOTHER: SEPSIS

UTERINE RUPTURE POSTPARTUM HAEMORRHAGE HYPOVOLAEMIC SHOCK URINARY OR FECAL FISTULA ANNULAR DETACHMENT OF THE CERVIX

ADEQUATE HYDRATION (R/L 1000CC) ADEQUATE ANALGESIA TRIPPLE ANTIBIOTIC COVERCATHETERIZATION ( 3 WEEKS) PREVENTION OF MENDELSON SYNDROME (PASS NASOGASTRIC TUBE/ENSURE GASTRIC EMPTYING 30CC ANTACID MIX 0.5 HR BEFORE SURGERY) CALL TO OPERATION THEATRE/ANAESTHETIST ULTRASOUND SCAN TO CONFIRM FETAL VIABILITY DO ROUTINE INVESTIGATIONS ARRANGE BLOOD

CAESAREAN SECTION.

THANK YOU