EDITORIAL COMMENT: We accepted this paper for publication to remind readers of the maternal and fetal hazards of obstructed labour in communities where obstetric hospitals still receive a high proportion of unbooked patients referred with intrapartum complications. The results reported for booked patients are also noteworthy; although the incidence of obstructed labour was only 1.7%, the 10,202 booked cases provided 19 cases ofCaesarean hysterectomy and 10 others where uterine rupture was treated by repair. The Caesarean section rate of all booked patients in this series is not provided but was presumably very low by western standards. The discussion provides a rare insight into the difficulties which occur in obstetric practice in other lands; even booked patients may refuse to go into hospital until it is too late to deliver them safely.
The maternal mortality rate in this series for the entire hospital population was 11 per 1,000 births, somewhat less than the 12.2 per 1,000 reported from the Royal Women's Hospital, Melbourne for the years 1939–1947A - at this time the perinatal mortality rate at the Royal Women's Hospital was 68.6 per 1,000 or approximately 50% higher than in this series reported for Nigeria. It is interesting to note that the Caesarean section rate at the Royal Women's Hospital during these years was 2%; it may be that conditions in the developing world are not all that different from the so called developed world of 40 years ago
Summary: Over a five year period (1985–1989) 527 cases of obstructed labour were recorded while 11,299 deliveries were conducted giving an incidence of 4.7%.
The majority of the patients (59%) were primigravidae. The incidence of obstructed labour was much higher for the unbooked patients (33 %) than for the booked patients (1.7%). Cephalopeivic disproportion was the greatest cause of obstructed labour (67%), while Caesarean section was the main method of delivery (85%).
The leading complications of obstructed labour were puerperal sepsis (57%), post partum haemorrhage (15%), uterine rupture (14%), and genital tract laceration (14%). A maternal mortality rate of 32 per 1000 and a perinatal mortality rate of 294 per 1000 were recorded.
Education of primary health providers and traditional birth attendants on the dangers of obstructed labour and the need for early referral is suggested to reduce the incidence of this condition. Governmental assistance is also required to improve existing health facilities so that antenatal and delivery services will be affordable to all pregnant women in the society.