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By Doctor Tsimbiri P.F.
Consultant Obstetrician and Gynecologist
Senior Lecturer Egerton University

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 Definition: OBSTRUCTED LABOUR is ''the failure of

the presenting part to descend in spite of adequate
coordinated uterine contractions

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CAUSES: An abnormality in a mother's pelvis (a contracted

pelvis).
 An abnormality of baby (hydrocephaly, Macrosomia
etc).
 An abnormality in the relationship between pelvis and
fetus. This can either be:- an abnormal lie or
presentation (a breech, a brow, or a face, or a shoulder
presentation, or a prolapsed arm in a transverse lie),
 coincidence of their relative sizes (CPD #cephalopelvic
disproportion#, he may be too big for her, or she may
be too small for him).
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Bony pelvis abnormality

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Pelvic cavity
 The single most important determinant to the mechanism

of labor is probably pelvic configuration
 The pelvic cavity is a body cavity that is bounded by the
bones of the pelvis and which primarily contains
reproductive organs and the rectum.
 A distinction is made between the lesser or true pelvis
inferior to the terminal line, and the greater or false pelvis
above it.
 The pelvic inlet or superior pelvic aperture, which leads
into the lesser pelvis, is bordered by the promontory, the
arcuate line, the iliopubic eminence, the pecten of the
pubis, and the upper part of the pubic symphysis.
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 Mid cavity is bounded by anteroposterioly by lower

margin of symphis pubis, laterally ishial spines
posterioly the sacrum at s3-s4.
 The pelvic outlet or inferior pelvic aperture is the
region between the subpubic angle or pubic arch, the
ischial tuberosities and the coccyx. [7]

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Caldwell-Moloy classification
 There are four types
 The gynaecoid pelvis (gyne, woman) is the so-called

normal female pelvis.

 Its inlet is either slightly oval, with a greater transverse

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diameter, or round.
The interior walls are straight, t
he subpubic arch wide, the sacrum shows an average to
backward inclination, and the greater sciatic notch is well
rounded.
Because this type is spacious and well proportioned there is
little or no difficulty in the birth process.
Caldwell and his co-workers found gynaecoid pelves in about
50 per cent of specimens.
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 The platypelloid pelvis ((platys, flat)
 has a transversally wide, flattened shape,
 is wide anteriorly,
 greater sciatic notches of male type, and
 has a short sacrum that curves inwards reducing the
diameters of the lower pelvis.
 This is similar to the rachitic pelvis where the...