9.3.1  Assessment of clinical signs of obstruction

Obstructed labour is more likely to occur if:

  • The labour has been prolonged (lasting more than 12 hours)
  • The mother appears exhausted, anxious and weak
  • Rupture of the fetal membranes and passing of amniotic fluid was premature (several hours before labour began)
  • The mother has abnormal vital signs: fast pulse rate, above 100 beats/minute; low blood pressure; respiration rate above 30 breaths/minute; possibly also a raised temperature.

You should assess a woman with this labour history by doing a vaginal examination. Any of the following additional signs would suggest the presence of obstruction:

  • Foul-smelling meconium draining from the mother’s vagina.
  • Concentrated urine, which may contain meconium or blood.
  • Oedema (swelling due to collection of fluid in the tissues) of the vulva (female external genitalia, including the labias), especially if the woman has been pushing for a long time. Vagina feels hot and dry to your gloved examining finger because of dehydration.
  • Oedema of the cervix.
  • A large swelling over the fetal skull can be felt (caput, Study Session 4).
  • Malpresentation or malposition of the fetus.
  • Poor cervical effacement (look back at Figure 1.1 in the first study session); as the result the cervix feels like an ‘empty sleeve’.
  • Bandl’s ring may be seen (Figure 9.2).

9.3  Clinical signs of obstructed labour

9.3.2  Bandl’s ring