¹Elizabeth Nionzima,²Wilfred Inzama,³Charles Otim Tom

¹Mulago Specialized Women and Neonatal Hospital, P. O Box 22081, Kampala, Uganda

²,³Lira University, P.O. Box 1035, Lira

Obstructed labour is a common preventable causes of both maternal and perinatal morbidity and mortality in developing countries affecting 3-6% labouring women globally and accounts for an estimated 8% of maternal deaths in Sub-Saharan Africa and South Asia.
Objective:
To determine the prevalence and outcome of obstructed labour in the Gynaecology and Obstetrics Department at a tertiary hospital in Northern Uganda.
Method:
This was a retrospective chart review of pregnant women admitted in labour and delivered by caesarean section from 1st January 2016 to 31st December 2017 at a Lira Regional Referral Hospital, a tertiary institution in Lango Sub region. Data was analysed using Statistical Package for Social Sciences version 16.0.
Results:
A total of 808 medical charts of mothers with obstructed labour were retrieved, evaluated and included in this review out of 12,189 deliveries during the study period, giving a prevalence of 6.6%. Majority (77%; 622/808) mothers admitted with diagnosis of obstructed were referred in from peripheral facilities. Over half (53.4%) of the women were in the age group of 20 to 29 years. Over 53%, were prime gravidae and were twice more likely to undergo C/S due to obstructed labour than multigravidas (OR 1.8; 95% CI 1.5-2.2). Only 49.2% had documented cause of obstructed labour, with Cephalo-pelvic disproportion being most common (17.5%), malposition/mal-presentation (14.6%), and macrosomia (3.6%). Partograph was used in only 46.6% (374) women who had obstructed labour. The commonest maternal complication observed were Sepsis (11%), PPH (5.2%), uterine rupture (4%) and burst abdomen (3%) which led to prolonged hospital stay and loss of fertility to some. Mode of delivery in the 808 reviewed charts was caesarean section, 90.3% of babies were born alive, while 8.5% (69) were born dead, (1.2%) had early neonatal, and 40.2% were referred Paediatric Neonatal Intensive Care Unit (NICU) because of low APGAR score.
Conclusion:
The prevalence of obstructed labour among women delivered by Caesarean section was high compared to the global average. Majority of the women were referrals from the peripheral health centres and associated with life threatening complications and even death. Young age and prime gravida is associated with obstructed labour and high caesarean section rates. The obstruction in multigravida could be due to secondary cephalo-pelvic disproportion as majority of the babies were in normal range weight. Low use of Partograph to monitor labour was evident among women who had obstructed.

Obstructed labour, Caesarean section, Maternal and Perinatal outcome.

1) Gupta. R and Porwal. S.K, "Obstructed labour: Incidence, causes and outcome," International Journal of Biological and Medical Research, vol. 3, no. 3, pp. 2185-2188, 2012.

2) Gessessew. A and Menengiste. M, "Obstructed labour in Adigrat Zonal Hospital, Tigray region, Ethiopia," Health Dev, vol. 17, no. 3, pp. 175-180, 2003.

3) Ranjana. A.S, "Incidence, causes and feto-maternal outcomes of obstructed in a tertiary health care centre," International Journal of Reproduction, Contraception, Obstetrics and Gynecology labour in a tertiary health care centre., vol. 6, no. 7, pp. 2817-2821, 2017.

4) Prual. A, Bouvier-Colle. M, Bernis. L.d. and Bréart. G, "Severe maternal morbidity from direct obstetric causes in West Africa: incidence and case fatality rates," Bull World Health Organ, vol. 78, no. 5, pp. 593-602, 2000.

5) Udoma. J.E, Asuquo. D.E, Mildred. E.J and Atim. I.E, "The role of institutional factors in Maternal Mortality from obstructed labour," Global Journal of Medical Sciences, vol. 2, no. 1, pp. 13-17, 2003.

6) Orach. C. G, "Maternal mortality estimated using the Sisterhooh method in Gulu District, Uganda," Tropical Doctor, vol. 30, no. 2, pp. 72-74, 2000.

7) Kabakyenga. J, Per-Olof. O, Eleanor, Turyakira, Peter. K. M, Karen, and Odberg. P, "Individual and health facility factors and the risk for obstructed labour and its adverse outcomes in South-Western Uganda," BMC Pregenancy and Childbirth, vol. 11, no. 73, 2011.

8) Ritu. G and Sanjay. K.P, "Obstructed Labour: Incidence, causes and outcome," International Journal of Biological & Medical Research, vol. 3, no. 3, pp. 2185-2188, 2012.

9) Asnakech. T.G,Tilaye. W.A, Fikiru. A.G, Godana and Guto. J, "Magnitude of Obstructed Labour and Associated Risk Factors among Mothers Come for Delivery Service in Adama Hospital Medical College, Oromia Regional State, Central Ethiopia," Ethiopia. Journal of Gynecology and Obstetrics, vol. 4, no. 3, pp. 12-16, 2016.

10) Henok. A and Asefa. A, " Prevalence of Obstructed Labour among Mothers Delivered in Mizan-Aman General Hospital, South West Ethiopia: A Retrospective Study," Journal of Women Health Care, vol. 250, p. 4, 2015.

11) Sharma. P, Kalpana. K, Vaibhav. K and Seth. S, "Obstructed Labour: A Preventable Tragedy but still a long way to go in Developing Countries," International Journal of Health Science and Research, vol. 5, no. 9, pp. 99-104, 2015.

12) Carmen.D and Carla.A, "Evidence and Information for Policy (EIP),World Health Organization, Geneva," Global burden of obstructed labourin the year 2000, 2000.

13) Henok. A and Asefa. A, "Prevalence of Obstructed Labour among Mothers Delivered in Mizan-Aman General Hospital, South West Ethiopia: A Retrospective Study.," Journal of Women’s Health Care, vol. 4, no. 250, pp. 4-5, 2015.

14) Shimelis. F, Hailemarian. S, and Fessahaye. A, "Incidence, causes and outcome of obstructed labour in Jima University specialized hospital," Ethiopian Journal of Health Science, vol. 20, no. 3, pp. 145-151, 2010.

15) Shaikh, S. Shaikh, A. Shaikh. SAH, and Isran. B, "Frequency of Obstructed Labour in Teenage Pregnancy," NJOG, vol. 7, no. 3, pp. 37-40, 2012.

16) Ahmed. E, EL. Nwobondo and Y "Obstructed labour: A public health problem in Sokoto, Nigeria," Sahel Medical Journal, vol. 14, no. 3, pp. 140-142, 2011.

17) WHO, "Appropriate technology for bbirth," Lancet, vol. 2, no. 8452, pp. 436-437, 1985.

18) Mi. J and Liu. F, "Rate of Caesarean section is alarming in China," Lancet, vol. 383, no. 9927, pp. 1463-4, 2014.

19) Priya. S, Kalpana. K, Vaibhav. K and Shikha.S, "Obstructed Labour: A Preventable Tragedy but Still a Long Way to Go In Developing Countries," International Journal of Health Sciences & Research, vol. 5, no. 9, pp. 99-104, 2015.

20) Kongnyuy. E, Mava. G and Broek. V, "Establishing standards for obstructed labour in low-income country Rural and Remote Health," Online, vol. 1022, no. 8, pp. 1-10, 2008.

21) Kadowa. I, "Ruptured uterus in rural Uganda: prevalence, predisposing factors and outcomes," Singapore Med Journal, vol. 51, no. 1, pp. 355-38, 2010.

22) Sabyasachi. M, Arunima. C, Gourisankar.K and Santra. D, "Fetomaternal outcome in obstructed labour in aperipheral tertiary care hospital," Medical Journal of Dr. D.Y. Patil University, vol. 6, no. 2, 2013.

23) Milton. W.M, Grace. N, Justus. K. B, Andrew. W, Victoria. N, Felix. W, Daniel. S, James. K.T and Julius. N.W, "Risk factors for obstructed labour in Eastern Uganda: A case control study," PLoS ONE, vol. 15, no. 2, 2020.

24) Omar. K, Hasim. S, Muhammad NA. J.A.H.S and Siraj. H, "Adolescent pregnancy outcome and risk fators in Malaysia," International Journal of Gynecology and Obstetrics, vol. 111, no. 3, pp. 220-223, 2010.

25) Naz.S, Paeveen. R, Bhatti. A, Baloch. R and Hanif. M, "Tennage pregnancy (Are tennager a risk group?)," Medical Channels of Pakistan Gynecology and Obsterics, pp. 140-143, 2010.

VOLUME 04 ISSUE 09 SEPTEMBER 2021