Audit of obstructed labour cases managed in a rural specialist hospital in Enugu, south-east, Nigeria

Abstract

Background: Labour is a physiological process through which the fetus and placenta are expelled from the vagina at term. It is a challenging and painful process that ends with the joy of a newborn. On many occasions, the process is complicated by obstruction arising from disproportion between the baby and the maternal pelvis. Such conditions if not detected on time, will lead to significant feto-maternal morbidities and mortality. This experience in the developing nations of the world is a recurrent one even though it is almost eliminated in the developed world due to their advancement in antenatal and intrapartum care. The condition is even more prevalent in the rural areas of the developing countries where scarcity of skilled birth attendants is the order of the day, hence, this 5-year review in a rural hospital. Aim: The aim of this study was to determine the prevalence, outcome and socio-demographic determinants of obstructed labour in a private rural hospital Methodology: This was a 5-year retrospective review of all cases of all cases of obstructed labour managed in a rural specialist hospital. The data was collected from delivery registers, theatre registers and patients’ case files using a specialized proforma. The data was analyzed using the Statistical Product and Service Solutions (SPSS) version 25.0 for windows. Results were presented using tables, frequencies, means, and percentages. Test of significance between class differences was by Pearson’s Chi-square test for categorical variables and student’s t-test for continuous variables. All P Result: From the data collected, records of 1,487 births in the centre over the 5-year period were reviewed. Out of these 123 were cases of obstructed labour giving a prevalence of 8.27%. The age distribution of the cases showed that majority of them (30.9%) were aged 30-35 years and the least were over 40 years (6.5%). In all, 75.6% were married and 22.8% were single; majority of them were in a monogamous relationship (65.9%). Those with primary education topped the list (42.3%) followed by those with secondary education (37.4%) while the least had tertiary education (1.6%). Forty eight percent of them were unemployed, followed by 46.3% who were petty traders and only 5.7% were civil servants. Almost all of them were Christians (83.7%) and 45.5% of their partners were artisans. Majority of them (60.2%) were para 3 or above and 64.2% were delivered at gestational ages of between 37 to 40 weeks whereas 32.8% were above 40 weeks. Fifty two percent were verbally referred to the centre and 1.6% had a written referral. Most of them 73.2% were referred from a Traditional Birth Attendant (TBA). They were all labouring outside of the facility and 69.9% were referred from a TBA homes. One hundred and seventeen (95.1%) had severe pain, 95.1% were dehydrated, 81% had edematous vulva, 24.4% presented in shock and 18.7% had vaginal bleeding. It also showed that 98.4% had significant moulding and caput, 84.6% fetal distress and 13.8% intrauterine fetal death. Many presented with a combination of these features. Almost all the parturients (98.4%) were rehydrated with intravenous fluids, 94.3% had analgesia, 92.7% had emergency caesarean delivery, 86.2% were transfused, 4.9% had destructive procedures, 5.7% were delivered vaginally, and 6.5% had hysterectomy. Majority of them (61.8%) had surgical site infections, 33.3% had PPH and 72.4% of the babies had birth asphyxia. In all, marital status, conjugal relationship and educational level had a significant relationship with obstructed labour with p-values less than 0.05. Conclusion: Obstructed labour was an important occurrence in the centre and all of them were referred cases. Marital status, type of conjugal relationship and educational qualification had significant influence on the condition and majority of the babies were asphyxiated at birth. Therefore, we recommend registration, training and retraining of TBAs in rural areas to recognize early signs of obstruction and make timely referrals. Secondly, policies to enhance girl child education and women empowerment should be encouraged. Finally, provision of health facilities to make Essential Obstetric Care available and affordable to the rural populace should be a priority of all regional governments