Interventions for Prolonged and Obstructed Labor including Obstetric Fistula

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Age Cohort: 25 - 59 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Community engagement on obstetric fistulas, causes, risk factors, treatment options and stigma reduction	Avoiding under age marriage and delaying the age of first pregnancy Delivery by a skilled attendance and timely access to obstetric care Elimination of harmful traditional practices.		Early recognition of need for referral
Primary Care
Community engagement on obstetric fistulas, causes, risk factors, treatment options and stigma reduction	Delivery by a skilled attendance and timely access to obstetric care Monitoring every labour by use of a partograph to identify those women who are at risk of, or who have developed obstructed labour Early identification and referral of high-risk mothers who are likely to develop obstructed labour		History and physical examination for diagnosis confirmation Indwelling urinary catheter for all mothers who have survived an obstructed labour Counselling on self-care Early referral to next level
Referral Facility: General
	Monitoring every labour by use of a partograph to identify those women who are at risk of, or who have developed obstructed labour Timely delivery by Caesarean section for high-risk mothers who are likely to develop obstructed labour		History and physical examination Basic laboratory tests Advance laboratory tests Basic imaging: x-ray, ultrasound, Appropriate management of infections Nutritional support Psych-social support Indwelling urinary catheter for all mothers who have survived an obstructed labour for closure of very small fistula without surgery Early referral for surgical repair
Referral Facility: Specialist
	Monitoring every labour by use of a partograph to identify those women who are at risk of, or who have developed obstructed labour Timely delivery by Caesarean section for high-risk mothers who are likely to develop obstructed labour		History and physical examination Basic laboratory tests Advance laboratory tests Basic imaging: x-ray, ultrasound, Transurethral catheterization Appropriate management of infections Nutritional support Surgical closure of an obstetric fistula		Psycho-social support Postoperative rehabilitation Longer-term accommodation and rehabilitation services by a special team with multidisciplinary expertise, counselling and skills

Age Cohort: Pregnancy and newborn

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
• Community awareness and engagement for identification of danger signs of pregnancy including symptoms and prevention of maternal haemorrhage • Posters on dangers of haemorrhage • Promote skilled birth attendance	Avoiding under age marriage Delaying age of first pregnancy Regular ANC attendance Delivery by a skilled attendance Support timely access to obstetric care Avoid harmful traditional practices such as FGM	Recognition of signs and symptoms	Immediate transfer to a higher-level health care facility	Social reintegration and rehabilitation of obstetric fistula patients before and after repair	Psychosocial support for physical and emotional recovery
Primary Care
Health education on danger signs of pregnancy including symptoms of prolonged and obstructed labour	Regular quality ANC Delivery in health facility Early detection of factors that may lead to prolonged or obstructed labour such as contracted pelvis, big baby, malpresentation or malposition Monitoring every labour using a partograph Timely referral of high-risk pregnant women	History Physical examination	Immediate transfer to a higher-level health care facility	Social reintegration and rehabilitation of obstetric fistula patients before and after repair	Psychosocial support for physical and emotional recovery
Referral Facility: General
Health education on danger signs of pregnancy including symptoms of prolonged and obstructed labour	Monitoring every labour by use of a partograph Timely delivery by Caesarean section for high-risk mothers who are likely to develop obstructed labour	History Physical examination Pelvic examination Partograph Assess presentation and position of the foetus Assess and monitoring descent of the foetal head and pelvic outlet Ultrasound	Artificial rupture of membrane Oxytocin augmentation to accelerate 1st stage labour Vacuum extraction or forceps delivery in 2nd stage of labour Symphysiotomy for women with obstructed labour and a live foetus Caesarean section delivery in confirmed cephalopelvic disproportion Destructive delivery in intrauterine foetal death in difficult vacuum delivery Avoid Caesarean section in obstructed labour with intrauterine foetal death Appropriate management of infections Appropriate fluid replacement and electrolyte balance Timely replacement of heavy blood loss	Social reintegration and rehabilitation of obstetric fistula patients before and after repair	Psychosocial support for physical and emotional recovery
Referral Facility: Specialist
Health education on danger signs of pregnancy including symptoms of prolonged and obstructed labour	Monitoring every labour by use of a partograph Timely delivery by Caesarean section for high-risk mothers who are likely to develop obstructed labour	History Physical examination Pelvic examination Assess presentation and position of the foetus Monitoring labour by use of a partograph Assess and monitoring descent of the foetal head and pelvic outlet	Artificial rupture of membranes Oxytocin augmentation in 1st stage labour Vacuum extraction in 2nd stage of labour Forceps delivery in 2nd stage of labour Symphysiotomy for women with obstructed labour and a live foetus Caesarean section delivery in confirmed cephalopelvic disproportion (CPD) Destructive delivery in intrauterine foetal death Destructive delivery in difficult vacuum delivery Avoid Caesarean section in obstructed labour with intrauterine foetal death Appropriate management of infections Appropriate fluid replacement and electrolyte balance Timely replacement of heavy blood loss	Social reintegration and rehabilitation of obstetric fistula patients before and after repair	Psychosocial support for physical and emotional recovery