Management of Obstructed Labour

Initial Management Approach

The American College of Obstetricians and Gynecologists recommends assessing for cephalopelvic disproportion (CPD) before proceeding with augmentation, which occurs in 25-30% of active phase arrest cases 1, 2
For active phase arrest without evidence of CPD, oxytocin augmentation should be the first-line treatment with a reported success rate of 92% for vaginal delivery 1

The American Society of Anesthesiologists recommends considering early insertion of a neuraxial catheter for anticipated difficult delivery to reduce the need for general anesthesia if an emergent procedure becomes necessary 3, 4
The American Society of Anesthesiologists suggests using dilute concentrations of local anesthetics with opioids for neuraxial analgesia to produce minimal motor block 3, 4
For cesarean delivery, neuraxial techniques are preferred over general anesthesia when possible 4

The American Journal of Obstetrics and Gynecology reports that reverse breech extraction may be associated with better neonatal outcomes, including improved Apgar scores and reduced NICU admissions, for cases with impacted fetal head during cesarean delivery 6

The American Journal of Obstetrics and Gynecology recommends considering anatomical differences that may affect anesthesia administration and adjusting fluid management according to the patient's size for patients with skeletal dysplasia 7

The American Society of Anesthesiologists recommends ensuring immediate availability of basic and advanced life-support equipment in the labour and delivery unit 8, 4
In case of cardiac arrest during labour, the American Society of Anesthesiologists suggests maintaining uterine displacement and performing cesarean delivery if maternal circulation is not restored within 4 minutes 4

The American College of Obstetricians and Gynecologists warns that failure to recognize the need for specialized equipment and personnel for difficult airway management can lead to adverse outcomes 5
The American College of Obstetricians and Gynecologists advises against underestimating the physiological changes of pregnancy, which can complicate airway management during emergency cesarean delivery 5