Obstructed labor: using better technologies to reduce mortality.
OBJECTIVE
To identify, from the best available evidence, underutilized and promising technologies that may reduce maternal mortality from obstructed labor.


METHODS
The author sought systematic reviews of randomized trials, individual randomized trials, and, in the absence of randomized data, non-randomized studies and clinical consensus. Data were presented according to the level of the evidence.


RESULTS
Obstructed labor causes approximately 8% of maternal deaths, and indirectly contributes to a greater percentage. Proven or widely accepted technologies that help reduce mortality from obstructed labor include contraception, external cephalic version, the partogram, augmentation of labor, selective amniotomy, selective episiotomy, vacuum extraction, caesarean section, symphysiotomy, and destructive procedures for non-viable fetuses. Technologies of uncertain usefulness include maternal height and shoe size, vaginal cleansing, upright posture for delivery and vaginal lubrication. Unuseful technologies include pelvimetry, estimating fetal weight, early labor induction, routine amniotomy and augmentation, routine episiotomy, and starvation during labor.


CONCLUSIONS
Access to well-established technologies, particularly safe caesarean section, can reduce maternal mortality in resource-poor countries.
Hofmeyr
G J
GJ
East London Hospital Complex, Effective Care Research Unit, University of Witwatersrand, South Africa. Gjh@global.co.za
D002585:Cesarean Section; D004420:Dystocia / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008427:Maternal Health Services / Q000458:organization & administration*; D008428:Maternal Mortality; D013677:Medical Laboratory Science; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D014620:Vacuum Extraction, Obstetrical