Abstract
Objective: The objective was to identify the characteristics of women who developed obstructed labor, the facilities where they were managed before the progress of labor became obstructed labor and also identify short term morbidities associated with the condition. This study was necessitated by the burden of obstetric fistula reported in this population previously thought not to have the challenge. Setting: The study was conducted in 3 tertiary centers including the Federal Teaching Hospital Abakaliki, the Ebonyi state University Teaching Hospital and Federal Medical Centre Owerri. Population: This study involved 225 consecutive parturient managed for obstructed labor in 3 tertiary hospitals in southeast Nigeria. Method: This was a retrospective study conducted between January 2004 and December 2008. Results: Most of the women were between 20-34 years old and more than half (55.1%) had only primary or no formal education. About 33% have not delivered before, while about one quarter (26.7%) had 5 or more previous deliveries. Majority (62.7%) were managed in private maternity homes before referral while 27.6% were referred from informal care providers like churches. Most women (55.6%) spent between 24-47 hours in labour before they were referred. Emergency caesarean section was performed in 81.8% of cases while repair of uterine rupture was done in 11.6%. When asked about the place of their last delivery 25.3% reported it was at an informal provider’s facility while 27 (12%) were in private maternities. Conclusion: There is need to eliminate the existence and patronage of informal maternity care providers while strengthening the capacity of private maternity facilities to manage labor in order to reduce the problem of obstructed labor.
Highlights
Obstructed labor remains a major cause of maternal morbidity and mortality worldwide in developing countries including Nigeria [1,2,3]
There is need to eliminate the existence and patronage of informal maternity care providers while strengthening the capacity of private maternity facilities to manage labor in order to reduce the problem of obstructed labor
Recent data suggests the prevalence remains high in sub Saharan Africa and Nigeria [5,6,7]
Summary
Obstructed labor remains a major cause of maternal morbidity and mortality worldwide in developing countries including Nigeria [1,2,3]. Labour is considered obstructed when the presenting part of the fetus cannot progress into the birth canal, despite strong uterine contractions [4]. Several interventions, such as advocacy for the use of the partograph to monitor labor and the provision of emergency obstetric care services have been proposed to reduce the scourge of obstructed labor and its sequelae. Perhaps there may be other factors and variables that seem to make obstructed labor a persistent and intractable condition unresponsive to interventions targeted at health facilities in developing countries
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