Llewellyn-Jones Fundamentals of Obstetrics and Gynaecology by Oats Jeremy & Abraham Suzanne

Author:Oats, Jeremy & Abraham, Suzanne [Oats, Jeremy]
Language: eng
Format: mobi
ISBN: 9780723437192
Publisher: Elsevier Health Sciences UK
Published: 2011-11-16T14:00:00+00:00

OBSTRUCTED LABOUR

Obstructed labour is the end result of a poorly managed or neglected labour, in which CPD or a shoulder presentation has not been detected early and timely intervention effected.

During an obstructed labour, uterine contractions attempt to overcome the obstruction. In a first labour the uterus contracts strongly for a while and then, failing to overcome the obstruction, becomes hypoactive, developing secondary arrest. In contrast, if the obstruction occurs in a subsequent labour, the uterus continues to contract strongly in an attempt to push the fetus through the maternal pelvis. With each contraction there is some myometrial shortening (retraction), the upper uterine segment becoming progressively thicker and shorter, and the lower segment becoming progressively stretched and thinner. The junction between the two segments becomes obvious, forming a pathological retraction ring – Bandl’s ring (Fig. 22.6). The pathological retraction ring may be confused with a distended urinary bladder, but the oblique line is diagnostic. The patient becomes dehydrated, with a coated tongue and dry lips. She has tachycardia and concentrated urine, and faces the risk of a ruptured uterus at any time.

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