Obstructed labour as an indication of operative delivery at Katima Mulilo state hospital, Katima Mulilo, Namibia
ENGLISH ABSTRACT: Background Obstructed labour is a major cause of maternal and child morbidity and mortality globally. However exact estimates is difficult to quantify as a result of causes of death being classified as resulting from any of obstructed labour complications like sepsis, uterine rupture and bleeding, amongst others. Aim and Objectives This study aims to determine the forms of obstructed labour as indications for operative deliveries at Katima Mulilo hospital in the Zambezi region, Namibia. The objectives are to determine the types of surgical interventions for obstructed labour and describe the stages of labour during which obstruction occurred. Methods All obstetric records of pregnant women of all ages who had operative deliveries, caesarean section or ventouse delivery, for various indications between 1st January and 31st December , 2011 at Katima Mulilo state hospital were selected for this research. Results Of the 117 patients that had surgery performed in 2011, 67 (57.3 %) had obstructed labour, 19 (16.2%) fetal distress, 17 (14.5%) pre-eclampsia and 12 (10.3%) previous caesarean section. Antepartum haemorrhage (APH), premature rupture of membrane (PROM) in retroviral disease (RVD), florid genital warts and post maturity with failed induction had 2 (1.7%) patients each. Cord prolapse was observed in 4 (3.4%) patients, elderly primigravidarity in 3 (2.6%) patients and elective caesarean section in 1 (0.9%) patient. Of the factors associated with obstructed labour, cephalopelvic disproportion (CPD) accounted for 19 (28.4%), abnormal presentation 17 (25.4%),delayed first stage 9 (13.4%), delayed second stage 7 (10.4%), breech in primigravida 5 (7.5%), abnormal lie 4 (6.0%), fetal macrosomia 3 (4.5%), cervical dystocia 2 (2.99%) and fetal malpositioning 1 (1.5%). Of the surgical procedures employed during the study period, caesarean section constituted 99.2% while vacuum extraction contributed an insignificant value of 0.8%. Forceps delivery was not employed at all. Conclusion Obstructed labour was the indication for the majority of operative deliveries. Cephalopelvic disproportion followed by abnormal presentation were the main reasons of obstructed labour at Katima Mulilo Hospital. Caesarean section and ventouse were the surgical interventions carried out forpatients with the former employed in nearly all of the patients. Efforts must be focused on improving antenatal care coverage, the referral system, and providing comprehensive obstetric care in health centres to prevent complications of unmanaged or poorly managed obstructed labour.