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      A five-year retrospective review of the maternal and feotal outcome of obstructed labour and its determinants in a tertiary hospital in Nigeria

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          Abstract

          Background

          Obstructed labour is one of the common obstetric emergencies in Nigeria which is associated with an increased maternal and foetal complications.

          Objective

          To determine the maternal and foetal outcome of obstructed labour and its determinants in a tertiary hospital in Ebonyi State University Teaching hospital Abakaliki

          Methods

          A retrospective review of all women with obstructed labour managed at Ebonyi State University Teaching hospital Abakaliki between January 2007 and December 2011 was carried out.

          Results

          The prevalence rate of obstructed labour was 3.4% (95%CI 3.37 – 3.42) for the period under review. Women in their second and third decade of life formed 91.6% (196/214) of patients in the study. Majority of obstructed labour occurred in primiparous women (92/214, 42.9%) and the commonest cause of obstructed labour was cephalopelvic disproportion (106/214, 49.6%). The commonest maternal complication was wound infection accounting for 23.2% (48/214) of all the complications. Most of the babies delivered had a good Apgar score as was noted in 60.3% (129/214) of cases. Being unbooked, para 3 and above, maternal age of 30 and above, having no formal education and rural residence were strongly associated with parturient having maternal complication (P > 0.05) and abnormal APGAR score. The maternal and perinatal mortality rate was 191/100,000 live births and 168/1000 deliveries respectively.

          Conclusion

          The commonest cause of obstructed labour in our review is cephalopelvic disproportion occurring more in primiparous women. Wound infection is the commonest maternal complication with majority of the neonates having a good outcome. Provision of free antenatal care services, education of women on the importance of antenatal care, early presentation in the hospital and early use of broad spectrum antibiotics would help to reduce the associated complications.

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          Most cited references36

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          WHO analysis of causes of maternal death: a systematic review.

          The reduction of maternal deaths is a key international development goal. Evidence-based health policies and programmes aiming to reduce maternal deaths need reliable and valid information. We undertook a systematic review to determine the distribution of causes of maternal deaths. We selected datasets using prespecified criteria, and recorded dataset characteristics, methodological features, and causes of maternal deaths. All analyses were restricted to datasets representative of populations. We analysed joint causes of maternal deaths from datasets reporting at least four major causes (haemorrhage, hypertensive disorders, sepsis, abortion, obstructed labour, ectopic pregnancy, embolism). We examined datasets reporting individual causes of death to investigate the heterogeneity due to methodological features and geographical region and the contribution of haemorrhage, hypertensive disorders, abortion, and sepsis as causes of maternal death at the country level. 34 datasets (35,197 maternal deaths) were included in the primary analysis. We recorded wide regional variation in the causes of maternal deaths. Haemorrhage was the leading cause of death in Africa (point estimate 33.9%, range 13.3-43.6; eight datasets, 4508 deaths) and in Asia (30.8%, 5.9-48.5; 11,16 089). In Latin America and the Caribbean, hypertensive disorders were responsible for the most deaths (25.7%, 7.9-52.4; ten, 11,777). Abortion deaths were the highest in Latin America and the Caribbean (12%), which can be as high as 30% of all deaths in some countries in this region. Deaths due to sepsis were higher in Africa (odds ratio 2.71), Asia (1.91), and Latin America and the Caribbean (2.06) than in developed countries. Haemorrhage and hypertensive disorders are major contributors to maternal deaths in developing countries. These data should inform evidence-based reproductive health-care policies and programmes at regional and national levels. Capacity-strengthening efforts to improve the quality of burden-of-disease studies will further validate future estimates.
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            Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

            In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015.
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              World Health Organization partograph in management of labour. World Health Organization Maternal Health and Safe Motherhood Programme.

              (1994)
              As part of the Safe Motherhood Initiative, launched in 1987, the World Health Organization have produced and promoted a partograph with a view to improving labour management and reducing maternal and fetal morbidity and mortality. This partograph has been tested in a multicentre trial in south east Asia involving 35,484 women. Introduction of the partograph with an agreed labour-management protocol reduced both prolonged labour (from 6.4% to 3.4% of labours) and the proportion of labours requiring augmentation (from 20.7% to 9.1%). Emergency caesarean sections fell from 9.9% to 8.3%, and intrapartum stillbirths from 0.5% to 0.3%. Among singleton pregnancies with no complicating factors, the improved outcome was even more marked, with caesarean sections falling from 6.2% to 4.5%. The improvements took place among both nulliparous and multiparous women. The World Health Organisation partograph clearly differentiates normal from abnormal progress in labour and identifies those women likely to require intervention. Its use in all labour wards is recommended.
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                Author and article information

                Journal
                Afr Health Sci
                Afr Health Sci
                African Health Sciences
                Makerere Medical School (Kampala, Uganda )
                1680-6905
                1729-0503
                June 2022
                : 22
                : 2
                : 500-510
                Affiliations
                [1 ] Department of Obstetrics and Gynaecology, Federal Teaching Hospital Abakaliki Ebonyi state
                [2 ] Department of Obstetrics and Gynaecology, Kubwa General Hospital Abuja Nigeria
                [3 ] Department of Administration, Federal Teaching Hospital Abakaliki Ebonyi state
                Author notes

                Email

                Chidebe Christian Anikwe – drchideanikwechristian@ 123456gmail.com ; Cyril Chijioke Ikeoha – ikeohacyril@ 123456gmail.com ; Collins Agbeze Kalu - drcollinsk@ 123456yahoo.com ; Christian Okechukwu Ogah - okeyogah2@ 123456gmail.com ; Ifeyinwa H Anikwechukwubuikemanikwe@ 123456gmail.com

                Corresponding author: Chidebe Christian Anikwe, Department of Obstetrics and gynaecology, Federal Teaching Hospital Abakaliki, P.M.B 102 Abakaliki, Ebonyi state. West Africa, Nigeria Phone number: +2348064165965 drchideanikwechristian@ 123456gmail.com
                Article
                jAFHS.v22.i2.pg500
                10.4314/ahs.v22i2.58
                9652698
                36407379
                172d3ad2-cb3d-4c03-848e-908fe651b507
                © 2022 Anikwe CC et al.

                Licensee African Health Sciences. This is an Open Access article distributed under the terms of the Creative commons Attribution License ( https://creativecommons.org/licenses/BY/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Articles

                obstructed labour,cephalopelvic disproportion,antenatal care,sepsis,haemorrhage,uterine rupture,abakaliki

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