Obstructed labor
Obstructed labor (or dystocia) is a violation of the birth process caused by abnormalities of fetal development or its incorrect presentation, pelvic abnormalities in a woman in labor or a discrepancy between the size of the fetus and the birth canal.
Obstructed childbirth is a rather serious problem in the field of obstetrics and gynecology, accounting for about 8% of maternal deaths in the world1. Considering that 99% of all maternal deaths occur in developing countries2, it becomes clear how great the chances of avoiding maternal death are with high-quality medical support.
CLASSIFICATION OF OBSTRUCTED LABOR
Obstructed labor is included in the classification of ICD-10 diseases in three sections at once, which determines their classification. The following types of obstructed labor are distinguished:
Caused by improper presentation or fetal position.
Caused by pelvic abnormalities in the mother.
Other types of obstructed labor (specified and unspecified).
Simply put, the two main causes of difficult labor are the incorrect position of the fetus in the uterus and too narrow birth canal (in a certain place or along the entire length). The remaining cases include the whole spectrum of possible disorders: fusion or coupling of twins, tumors, hydrocephalus, etc., however, they are extremely rare.
Let’s focus on the more common variants of obstructed labor.
PRESENTATION OF THE FETUS: PATHOLOGY AND NORM
Very often, the birth process is complicated by incorrect presentation of the fetus. Head presentation is considered normal: the position in which the baby’s head comes out of the uterus (and from the vagina) in the first place. However, in some cases, the fetus may be positioned incorrectly.
There are gluteal, facial and frontal presentation, as well as shoulder presentation. In the first case, the fetus is turned to the cervix with buttocks or legs, facial and frontal presentation suggests an incorrect position of the head, and in the case of shoulder presentation, the fetus is located in the uterus “across” the birth canal.
All the described cases are subject to correction, but in order to implement it, it is necessary to determine the risks in time and prepare for possible difficult childbirth. In this matter, a large degree of responsibility lies with the pregnant woman herself, which does not negate the need to improve her qualifications for a doctor. We will return to the risk factors in more detail below.
CAUSES AND CONSEQUENCES OF OBSTRUCTED LABOR
As already mentioned, difficult childbirth is most often caused by improper presentation and the problematic structure of a woman’s pelvis. In critical cases, difficult labor can result in the death of the fetus or newborn, and even the death of the woman in labor herself.
So, for example, in the case of a very large fetus (compared to the pelvis of a woman in labor), shoulder dystocia is possible – a pathology in which the fetus gets stuck at the exit from the vagina: the baby’s head is already outside, while the shoulder rests against the pubic bone.
If the pelvis is not wide enough, the fetus may get stuck in the birth canal. If the fetal head rests against the mother’s sacrum, serious injuries to his skull are possible.
In the case of breech presentation, complications are possible caused by an attempt by an obstetrician to help the woman in labor and “pull out” the fetus. This type of presentation is also dangerous because it is very difficult for a doctor to make a decision on the need for a cesarean section in time: this question arises at the moment when the fetus has left the uterus to the shoulder girdle, and in most cases (with breech presentation) it is too late to do a caesarean section.
Thus, difficult childbirth is fraught with birth trauma, stillbirth or the death of a newborn. In critical cases, you can lose the life of a woman in labor.
RISK FACTORS AND PREVENTION OF DYSTOCIA
Since difficult labor is often the result of a too narrow pelvis, teenage pregnancies are at risk. In addition, women who do not receive proper medical care or refuse it for any personal reasons (religious, family, social, etc.) may face dystocia.
The position and size of the fetus are easily determined during the examination: by palpation, X-ray examination, ultrasound. Timely examination allows you to prepare for possible complications.
Difficult childbirth is not a verdict, but a risk. In order to protect herself and the baby, a woman should responsibly approach the issue of choosing a doctor and not neglect the need for regular consultations with a gynecologist leading a pregnancy.
1 According to WHO data for 2005.
2 According to WHO data for 2013.
