Simulation of Urgent Obstructed Delivery: Scenario and Triage

Abstract

Obstructed labor is a preventable labor complication with significant associated perinatal morbidity. Worldwide obstructed labor is a major cause of maternal and neonatal mortality. The most common risk factors for obstructed labor include prolonged second stage of labor, fetal malpresentation, cephalopelvic disproportion, and Bandl’s ring formation. Complications of obstructed labor include postpartum hemorrhage, renal failure, stillbirth, sepsis, uterine rupture and obstetric fistula. Management of obstructed labor includes maternal resuscitation followed by urgent delivery, usually by cesarean. Decision-making on the mode of delivery can be assisted by ultrasound. Manual rotation can be employed if warranted based on fetal position. Operative vaginal delivery may be an option in cases of mild obstructed labor and low station. In the case of cesarean delivery, consideration with respect to maternal position and uterine incision should be employed. Delivery at cesarean may also be assisted by use of the uphill hand, the pull vs push method, the shoulder first method, abdominovaginal delivery, or medical devices such as the fetal pillow.