Obstructed labor: using better technologies to reduce mortality

Abstract

Objective: To identify, from the best available evidence, underutilized and promising technologies that may reduce maternal mortality from obstructed labor. Methods: The author sought systematic reviews of randomized trials, individual randomized trials, and, in the absence of randomized data, non-randomized studies and clinical consensus. Data were presented according to the level of the evidence. Results: Obstructed labor causes approximately 8% of maternal deaths, and indirectly contributes to a greater percentage. Proven or widely accepted technologies that help reduce mortality from obstructed labor include contraception, external cephalic version, the partogram, augmentation of labor, selective amniotomy, selective episiotomy, vacuum extraction, caesarean section, symphysiotomy, and destructive procedures for non-viable fetuses. Technologies of uncertain usefulness include maternal height and shoe size, vaginal cleansing, upright posture for delivery and vaginal lubrication. Unuseful technologies include pelvimetry, estimating fetal weight, early labor induction, routine amniotomy and augmentation, routine episiotomy, and starvation during labor. Conclusion: Access to well-established technologies, particularly safe caesarean section, can reduce maternal mortality in resource-poor countries.