Abstract
Analysis of 146 patients managed for obstructed labour at a referral tertiary hospital in South West Nigeria shows that labour became obstructed in a lower cadre health facility among majority (76.7%) of the women. This calls for improved maternity service delivery in our locality.
Obstructed labour is a common obstetric problem in developing countries, contributing significantly to maternal morbidity and mortality. 1 This is believed to be due to widespread poverty, ignorance and illiteracy, resulting in the poor utilization of the limited health-care services. Thus, pregnant women often do not receive antenatal care and unsupervised delivery at home is common. 2 Mass education to increase the utilization of health-care facilities and provision of accessible, affordable and qualitative maternity care are measures that are being introduced to prevent occurrences of obstructed labour. Despite this, women continue to present with this potentially fatal, but largely preventable, condition. 3
The Federal Medical Centre, Ido Ekiti, is a tertiary health institution located in Ekiti State, southwest Nigeria. It is the largest hospital in Ekiti State and a main referral centre for a number of private and government owned primary and secondary health facilities spread throughout the state. It provides specialist obstetrics care for patients presenting with complications during pregnancy and labour. We reviewed all cases of obstructed labour managed in the hospital over a two-year period from 1 January 2005 to 31 December 2006. During the period, there were 146 cases of obstructed labour out of 2176 total deliveries. Thus, the incidence of obstructed labour is 6.7% of the total deliveries.
An analysis of the women, based on the place of labour before presentation at our hospital, is as shown in Table 1. Only six (4.1%) women went into labour at home: 112 (76.7%) patients went into labour at a health facility. The observed difference was statistically significant (P = 0.000). Also, a fifth of the patients were referred from general hospitals which, as secondary health facility, should ordinarily have been well equipped to carry out a caesarean section. “Thus, women are leaving their homes to avoid the long delays and general neglect of going into labour at home but arrive at the health facility only to be confronted with substandard care and institutional delays. Obstructed labour should not occur in the presence of skilled attendants.
Analysis of the patients based on the place of labour
Therefore there is an urgent need to ensure that our health facilities are provided with the full complement of well-trained staff necessary for early recognition of high risk cases and prompt intervention or referral. Midwives at the primary health-care level should be properly trained in the use of the partograph. Training and re-training of medical staff at the secondary level of care are needed, and necessary equipment and the utilities for early and appropriate interventions must be provided.