A term multigravida is in labour since 12 hours. O/E PR: 116/min, BP is 90/60, tongue is dry, uterine contractions of 45 sec felt every 3 mins, cervix is thick, 6-7 cm dilated, membranes are absent, fetal head is at station -2 with a caput till +3 station. Urine is blood stained. The most likely diagnosis is:-
This is a case of obstructed labour since patient is in labour for a relatively long duration despite good contractions, there are signs of dehydration, excessive caput and blood stained urine due to prolonged compression of bladder OBSTRUCTED LABOR Obstructed labor is one in which inspite of good uterine contractions, the progressive descent of the presenting pa is obstructed due to mechanical obstruction Causes Cephalopelvic dispropoion Soft tissue obstruction Malpresentations and malpositions Big or malformed fetus Clinical features and complications Maternal exhaustion Dehydration Genital sepsis Caput succadeneum: accumulation of fluid anterior to girdle of contact Uterine rupture Fetal ashyxia, acidosis, intracranial hemorrhage, death PPH Hematuria: as base of bladder is compressed between pubic symphysis and presenting pa Shock Genitourinary fistula: delayed complication secondary to pressure necrosis
Patient is in advance labour with expected findings
Prolonged labour
Obstructed labour
Shoulder Dystocia
Labour - normal, abnormal, malposition, malpresentation and their management