Obstructed labour, also known as labour dystocia, is the baby not exiting the pelvis because it is physically blocked during

childbirth Childbirth, also known as labour, parturition and delivery, is the completion of pregnancy, where one or more Fetus, fetuses exits the Womb, internal environment of the mother via vaginal delivery or caesarean section and becomes a newborn to ...

although the

uterus The uterus (from Latin ''uterus'', : uteri or uteruses) or womb () is the hollow organ, organ in the reproductive system of most female mammals, including humans, that accommodates the embryonic development, embryonic and prenatal development, f ...

contracts normally. Complications for the baby include not getting enough oxygen which may result in death. It increases the risk of the mother getting an

infection An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...

, having uterine rupture, or having post-partum bleeding. Long-term complications for the mother include obstetrical fistula. Obstructed labour is said to result in prolonged labour, when the active phase of labour is longer than 12 hours. The main causes of obstructed labour include a large or abnormally positioned baby, a small

pelvis The pelvis (: pelves or pelvises) is the lower part of an Anatomy, anatomical Trunk (anatomy), trunk, between the human abdomen, abdomen and the thighs (sometimes also called pelvic region), together with its embedded skeleton (sometimes also c ...

, and problems with the birth canal. Abnormal positioning includes shoulder dystocia where the anterior shoulder does not pass easily below the

pubic bone In vertebrates, the pubis or pubic bone () forms the lower and anterior part of each side of the hip bone. The pubis is the most forward-facing (ventral and anterior) of the three bones that make up the hip bone. The left and right pubic bones ar ...

. Risk factors for a small pelvis include

malnutrition Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is a deficiency, excess, or imbalance of energy, protein and other nutrients which adversely affects the body's tissues a ...

and a lack of exposure to sunlight causing

vitamin D deficiency Vitamin D deficiency or hypovitaminosis D is a vitamin D level that is below normal. It most commonly occurs in people when they have inadequate exposure to sunlight, particularly sunlight with adequate ultraviolet B rays (UVB). Vitamin D def ...

. It is also more common in

adolescence Adolescence () is a transitional stage of human Developmental biology, physical and psychological Human development (biology), development that generally occurs during the period from puberty to adulthood (typically corresponding to the age o ...

as the pelvis may not have finished growing by the time they give birth. Problems with the birth canal include a narrow vagina and perineum which may be due to

female genital mutilation Female genital mutilation (FGM) (also known as female genital cutting, female genital mutilation/cutting (FGM/C) and female circumcision) is the cutting or removal of some or all of the vulva for non-medical reasons. Prevalence of female ge ...

tumors A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

. A partograph is often used to track labour progression and diagnose problems. This combined with physical examination may identify obstructed labour. The treatment of obstructed labour may require cesarean section or

vacuum extraction Vacuum extraction (VE), also known as ventouse, is a method to assist delivery of a baby using a vacuum device. It is used in the second stage of labor if it has not progressed adequately. It may be an alternative to a forceps delivery and ca ...

with possible surgical opening of the symphysis pubis. Other measures include: keeping the women hydrated and

antibiotic An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting pathogenic bacteria, bacterial infections, and antibiotic medications are widely used in the therapy ...

s if the membranes have been ruptured for more than 18 hours. In Africa and Asia obstructed labor affects between two and five percent of deliveries. In 2015 about 6.5 million cases of obstructed labour or uterine rupture occurred. This resulted in 23,000 maternal deaths down from 29,000 deaths in 1990 (about 8% of all deaths related to pregnancy). It is also one of the leading causes of

stillbirth Stillbirth is typically defined as fetus, fetal death at or after 20 or 28 weeks of pregnancy, depending on the source. It results in a baby born without vital signs, signs of life. A stillbirth can often result in the feeling of guilt (emotio ...

. Most deaths due to this condition occur in the

developing world A developing country is a sovereign state with a less-developed industrial base and a lower Human Development Index (HDI) relative to developed countries. However, this definition is not universally agreed upon. There is also no clear agreeme ...

Cause

The main causes of obstructed labour include a large or abnormally positioned baby, a small

, and problems with the birth canal. Both the size and the position of the fetus can lead to obstructed labor. Abnormal positioning includes shoulder dystocia where the anterior shoulder does not pass easily below the

. A small pelvis of the mother can be a result of many factors. Risk factors for a small pelvis include

and a lack of exposure to sunlight causing

. A deficiency in calcium can also result in a small pelvis as the structures of the pelvic bones will be weak due to the lack of calcium. A relationship between maternal height and pelvis size is present and can be used to predict the possibility of obstructed labor. This relationship is a result of the mother's nutritional health throughout her life leading up to childbirth. Younger mothers are also at more risk for obstructed labor due to growth of the pelvis not being completed. Problems with the birth canal include a narrow vagina and perineum which may be due to

. All of these factors lead to a failure in the progress of labor.

Evolution

Obstructed labor is more common in

human Humans (''Homo sapiens'') or modern humans are the most common and widespread species of primate, and the last surviving species of the genus ''Homo''. They are Hominidae, great apes characterized by their Prehistory of nakedness and clothing ...

s than any other species and continues to be a main cause of birth complications today. Modern humans have morphologically evolved to survive as bipeds, however,

bipedalism Bipedalism is a form of terrestrial locomotion where an animal moves by means of its two rear (or lower) Limb (anatomy), limbs or legs. An animal or machine that usually moves in a bipedal manner is known as a biped , meaning 'two feet' (from ...

has resulted in skeletal changes that have consequently narrowed the pelvis and the birth canal. The combination of increased brain size and changes in

pelvic The pelvis (: pelves or pelvises) is the lower part of an anatomical trunk, between the abdomen and the thighs (sometimes also called pelvic region), together with its embedded skeleton (sometimes also called bony pelvis or pelvic skeleton). ...

structure are the major contributors of obstructed labor in modern humans. It is also common for obstructed labor in humans to be caused by the fetus' broad shoulders. However, morphological shifts in pelvic structure still account for the inability of a fetus to effectively pass through the birth canal without major complications Other primates have a wider and straighter birth canal that allows a fetus to pass through more effectively. Mismatch between birth canal size and infant cranial width and length due to bipedal locomotion requirements have often been referred to as the obstetric dilemma, since compared to other great apes, modern humans have the greatest disproportion between infant cranial size and birth canal size. Shrinking of upper extremities and curvature of the spine have also affected the way modern humans give birth. Quadruped apes have longer upper limbs that allow them to reach down and pull their fetus out of the birth canal unassisted. Modern human's shorter upper extremities and evolution of bipedal locomotion may have placed a premium on assistance during labor. For this reason, researchers argue that assisted labor may have evolved with

. Obstructed labor has been documented as a complication of childbirth since the field of

obstetrics Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a su ...

originated. For over 1,000 years obstetricians have had to forcibly remove obstructed labor fetuses to prevent the death of the mother. Prior to the existence of the cesarean section, fetuses that were obstructed had a low survival rate. Even in the 21st century, if obstructed labor is left untreated, it could result in mother and infant death. Although surgical removal of the fetus is the preferred method of managing obstructed labor, manual removal using medical tools is also common.

Diagnosis

Obstructed labour is usually diagnosed based on physical examination. Ultrasound can be used to predict malpresentation of the fetus. In examination of the cervix once labor has begun, all examinations are compared to regular cervical assessments. The comparison between the average cervical assessment and the current state of the mother allows for a diagnosis of obstructed labor. An increasingly long time in labor also indicates a mechanical issue that is preventing the fetus from exiting the womb.

Prevention

Access to proper health services can reduce the prevalence of obstructed labor. Less developed areas have inadequate health services to attend to obstructed labor, resulting in a higher prevalence among less developed areas. Improving nutrition of female, both before and during pregnancy, is important for reducing the risk of obstructive labor. Creating education programs about reproduction and increasing access to reproductive services such as contraception and family planning in developing areas can also reduce the prevalence of obstructed labor.

Treatment

Before considering surgical options, changing the posture of the mother during labor can help to progress labor. The treatment of obstructed labour may require cesarean section or vacuum extraction with possible surgical opening of the symphysis pubis. Caesarean section is an invasive method but is often the only method that will save the lives of both the mother and the infant. Symphysiotomy is the surgical opening of the symphysis pubis. This procedure can be completed more rapidly than Caesarean sections and does not require anesthesia, making it a more accessible option in places with less advanced medical technology. This procedure also leaves no scars on the uterus which makes further pregnancies and births safer for the mother. Another important factor in treating obstructed labor is monitoring the energy and hydration of the mother. Contractions of the uterus require energy, so the longer the mother is in labor the more energy she expends. When the mother is depleted of energy, the contractions become weaker and labor will become increasingly longer. Antibiotics are also an important treatment as infection is a possible result of obstructed labor.

Prognosis

If cesarean section is obtained in a timely manner, prognosis is good. Prolonged obstructed labour can lead to

obstetric fistula Obstetric fistula is a medical condition in which a hole develops in the birth canal as a result of childbirth. This can be between the vagina and rectum, ureter, or bladder. It can result in incontinence of urine or feces. Complications may ...

, and

maternal death Maternal death or maternal mortality is defined in slightly different ways by several different health organizations. The World Health Organization (WHO) defines maternal death as the death of a pregnant mother due to complications related to p ...

. Fetal death can be caused by asphyxia. Obstructed labor is the leading cause of uterine rupture worldwide. Maternal death can result from uterine rupture, complications during caesarean section, or sepsis.

Epidemiology

In 2013 it resulted in 19,000 maternal deaths down from 29,000 deaths in 1990. Globally, obstructed labor accounts for 8% of maternal deaths.

Etymology

The word ''dystocia'' means 'difficult labour'. Its

antonym In lexical semantics, opposites are words lying in an inherently incompatible binary relationship. For example, something that is ''even'' entails that it is not ''odd''. It is referred to as a 'binary' relationship because there are two members i ...

is ''eutocia'' ( + ) 'easy labour'. Other terms for obstructed labour include difficult labour, abnormal labour, difficult childbirth, abnormal childbirth, and dysfunctional labour.

Other animals

The term can also be used in the context of various animals. Dystocia pertaining to birds and reptiles is also called egg binding. In part due to extensive selective breeding, miniature horse mares experience dystocias more frequently than other breeds. Most

brachycephalic Brachycephaly (derived from the Ancient Greek '' βραχύς'', 'short' and '' κεφαλή'', 'head') is the shape of a skull shorter than average in its species. It is perceived as a cosmetically desirable trait in some domesticated dog and ...

dogs require

caesarean section Caesarean section, also known as C-section, cesarean, or caesarean delivery, is the Surgery, surgical procedure by which one or more babies are Childbirth, delivered through an incision in the mother's abdomen. It is often performed because va ...

s to decrease risk of mortality for both the bitch and puppies. In the Boston Terrier, French Bulldog, and the

Bulldog The Bulldog is a British breed of dog of mastiff type. It may also be known as the English Bulldog or British Bulldog. It is a stocky, muscular dog of medium size, with a large head, thick folds of skin around the face and shoulders and a rel ...

more than 80% of births require caesarean sections. File:Miniature Horse Dystocia.jpg, Assisted delivery: miniature horse dystocia. Note the position of the head. File:Miniature Horse Dystocia. Note the position of the head.jpg, Miniature horse dystocia. Note the position of the head.