Obstructed labour: risk and determinants of intraoperative and early postoperative complications in women delivered by caesarian section in Mulago Hospital.

Abstract

INTRODUCTION: Obstructed labour is a major cause of maternal morbidity and mortality. The preferred mode of delivery in most cases is caesarean section (CS). During CS, the pathophysiologic sequel of the obstruction pose many challenges to the surgeon and these are likely to increase morbidity. In this study, we sought to document the incidence and risk ratios for intraoperative and early postoperative complications of CS in obstructed labour and determine predictors of intra operative laceration and hemorrhage above one litre in women managed in Mulago Hospital. METHODS: This was a cohort study involving189 women undergoing emergency CS in Mulago Hospital. Those with obstructed labour were the exposed group. Consecutive sampling was used and subjects followed up to 24 hours postoperatively. The main outcome variables were estimated intraoperative haemorrhage over a litre and uterine laceration/tears. RESULTS: The incidence of intraoperative laceration in caesarean section for obstructed labour was 50% and hemorrhage above one litre 27.1%. Women undergoing CS for obstructed labour were 9 times more likely to sustain lacerations (RR 9.3(3.9-22.3)} and 5 times more likely to have haemorrhage above one litre {RR 5.0(2.0-12.6)}. Increased parity, increased age and descent of 3/5 or more were identified as independent pre-operative risk factors for these complications. Methods of delivery of an impacted head affected the extent and direction of laceration, but not whether a laceration was sustained or not. It also affected the amount of blood loss. CONCLUSION: The incidence of complications during emergency C/S is much higher in obstructed labour than other indications for C/S. There is need to review protocols for management of patients diagnosed with obstructed labour in line with available evidence.