Incidence, causes and outcome of obstructed labor: Jimma, south west Ethiopia

Abstract

Introduction: Obstructed labor is one of the common preventable causes of maternal and perinatal morbidity and mortality in developing countries including Ethiopia. The common causes are cephalopelvic disproportion, malpresentation and malposition, and the prevalence is high in communities in which childhood malnutrition is dominant and where there is no easy access to health facilities. Objective: The objective of this study was to assess the incidence, causes and outcomes of obstructed labor among women gave birth in the study facilities. Methods: Facility based multicenter cross sectional study design was conducted on all mothers who were admitted and delivered in the labor ward of five hospitals found in Jimma Zone (Jimma University Medical Center, Shenen Gibe Hospital, Limmu Genet Hospital, Agaro Hospital and Seka Chekorsa Hospital).The data was collected by using semi-structured pretested questionnaire by face-to-face interview. Data was edited and entered into Epidata version 3 and then exported to SPSS version 20 for cleaning and analysis. Results: There were 7523 total deliveries and the incidence of OL was found to be 2.4%. One hundred sixty (89.4%) of the cases have any ANC follow up of at least one visit. 123 (68.7%), 77 (43%), and 97 (54.2%) of patients with obstructed labor had delay one, two and three respectively. The causes of obstructed labor were cephalo-pelvic disproportion secondary to malposition in 84(46.9%) and malpresentation in 73 (40.8%) of the cases. The commonest maternal complications observed were anemia 63 (43%) uterine rupture in 52 (35%) and sepsis in 21 (14%) of the cases with complications. Mother with Para 2 to 4, Para 5 and above, unknown fetal presentation and adverse perinatal outcome were significantly associated with severe maternal outcome,5.3,6.2, 14.1 and 61.4times compared to primaparous, vertex presentation and no adverse perinatal outcome respectively. Case fatality rate was 1.1%. Fifty eight (32.4%) case have organ dysfunction (near miss). The perinatal mortality rate was 407.8 per 1000 births. The birth weight of the 139 (77.7%) of the newborns was in the normal range (2500-3999 grams). Adverse perinatal outcome was associated with mothers having delay one 8.5 times and mothers who had severe maternal outcome 18.2 times. CONCLUSION AND RECOMMENDATION: The magnitude of obstructed labor had decreased dramatically from the previous studies done in Ethiopia this might be due increased health facility delivery and antenatal care coverage. But the maternal morbidity, mortality and perinatal mortality from obstructed labor is still higher. Cephalopelvic disproportion secondary to malposition and malpresentation are the main causes of obstructed labor. The majority of them had antenatal care at least once, but quality might be poor and the care may not address about the birth preparedness and complication readiness. Anemia, uterine rupture and sepsis were the most common complication faced by mothers with obstructed labor. Improving quality of antenatal care, referral system, availing comprehensive obstetric care in nearby health institution and improving community awareness are recommended to prevent obstructed labor and its complications