Prepared by:
1
Definition
2
Cause:
Maternal: Fetal:
1. Malpresentation:
1. Contracted pelvis and 1. Transverse lie
CPD 2. Brow presentation
3. Compound
2. Soft tissue mass or presentation
Lower tract scarring 2. Hydrocephalous
3. Conjoined or Locked
twin
3
Retraction ring formation
Increased contraction
Decreased relaxation
Tonic contraction
+
Continued retraction
Retraction ring
(Bandl’s ring)
4
Retraction ring formation
Primigravida Multigravida
Retraction continues
5
Clinical features
S/S: P/A:
• Upper segment hard/tender
• Agonising pain
• Exhaution • Lower segment distended/tender
• Dehydration
• Ketoacidosis • Oblique ring between umbilicus &
symphysis
P/V:
• Taut tender round ligament
• Vagina dry, hot,
offensive discharge • Fetal part ?/FHS?
• Cx dilated
• No membrane
6
Complication
Maternal: Fetal:
• Ruptured uterus/Shock
1. Asphyxia
• Metabolic acidosis
(lactate/ketone)
• Genital sepsis/Septicemia 2. Acidosis
• PPH
• Genito-urinary fistula/RVF 3. Intracranial bleeding
• Sheehan’s syndrome
• Fetal/Maternal death
4. Perinatal death
7
Management
• Treat sepsis: Broad
• Correction of:- spectrum antibiotics
1. Dehydration 1. Gm+ve Ampicillin
2. Ketoacidosis 2. Gm-ve Gentamicine /
3. Hemorrhagic shock: Ceftriaxone
– Blood grouping 3. Anerobe Metronidazole
– x-matching • Release obstruction
– Transfusion • Cesarean section/
Laparotomy