Obstructed labor (OL) needs to be addressed effectively so as to reduce maternal morbidity and
mortality and also improve fetal outcome. We conducted this study to establish the incidence, predisposing factors of
OL and to compare birth outcome of OL to normal labor from three rural district hospitals in north-west Rwanda.
Retrospective case–control design of women with OL from January to December 2011. OL was diagnosed as
documentation of any or all the four pre-specified criteria and these were; i) crossed action line on partogram, ii)
membranes ruptured, iii) oxytocin augmentation done, iv) and in second stage when was assisted vaginal delivery
performed. Any cases with documented OL and fulfilled all our four pre-specified criteria were considered “with
diagnosis”. The remaining cases were considered “without diagnosis”. The cases were retrospectively collected from
the patients’ case files at the hospital archives office. Controls were women who had spontaneous vaginal delivery
(SVD) or were delivered by vacuum extraction without OL as a complication. For every case, three consecutive
patient’s file were picked and retrieved as controls. All available case files were retrieved from hospital’s archives
office. Every fourth woman was recorded as OL. The incidence of documented OL with diagnosis was (n=299;
3.7%) and without diagnosis was (n=1780; 21.9%). The predisposing factors for OL were maternal age <19 years,
primiparas status, attending < 4 antenatal care (ANC), no formal or primary education and being resident of one
specific district. Maternal complications were two and half times higher among women with OL (n=252/2079;
12.1%) compared to those with SVD (n=327/6054; 5.4%), with OR 2.5 (2.0-3.0). Puerperal sepsis and transfusion
were more common in women with OL. There was significant difference in the rate of the composite maternal
outcome between OL and SVD (4.10% vs. 2.0%; OR 1.9, 95% CI 1.6-4.7) and after adjusting for confounding
variables with multivariable logistic regression (OR = 3.1, CI: 1.9-8.7; p = <0.01). There were 28 maternal deaths
from the three hospitals giving maternal mortality ratio of (n=28/8133; 344/100,000 live births), of which 4 maternal
deaths were due to OL with a case fatality rate of 0.19%. Perinatal mortality rate in OL was (n=123; 59 per 1000
OLs) compared to SVD (n=169; 28 per 1000 SVDs). OL is over diagnosed by the clinicians from rural Rwanda.
Increasing clinical skills and a good documentation for the progress of labor is paramount for early identification and
prevention of OL, in order to improve care for both women and infants. Improving girl child education, referral
system, quality of ANC, availing comprehensive obstetric care in nearby health institution are recommended to
prevent OL and its complications.