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Add sentence: Preventable cause of both maternal and infant death that is very common in developing countries. Add intro to being unique to humans due to evolution. Edit beginning of second paragraph which is just a copy of the Cause section. Edit beginning of third paragraph which is just a copy of the Treatment section.

Evolutionary Aspects (new section)

Obstructed labor is unique to humans compared to other primates. The evolution of humans to become obligate bipedal and increase in brain size create the problems associated with obstructed labor. In order for bipedal locomotion to be possible, many changes had to occur to the skeletal structure of humans, especially in the pelvis. Both the shape and orientation of the pelvis changed. Other primates have straighter and wider pelvises compared to humans.(CITE as source 11 on original article) A narrow pelvis is better for bipedal locomotion but makes childbirth more difficult. The pelvis is sexually dimorphic, with females having a wider pelvis to be better suited for childbirth. However, the female pelvis still must accommodate for bipedal locomotion which is what creates the challenges for obstructed labor. The brain size of humans have also increased as the species has evolved. This creates a larger head of the fetus that must exit the womb. This requires human infant to be born less developed when compared to other species. The bones of the skull are not fused when a human infant is born in order to prevent the head from becoming too large to exit the womb. The head of the fetus is still large and poses the possibility for obstructed labor.

Cause

(Sentence 1). Both the size and the position of the fetus can lead to obstructed labor. (Sentence 2). A small pelvis of the mother can be a result of many factors. (Sentence 3). A deficiency in calcium can also result in a small pelvis as the structures of the pelvic bones will be weak due to the lack of calcium. A relationship between maternal height and pelvis size is present and can be used to predict the possibility of obstructed labor. This relationship is a result of the mother's nutritional health throughout her life leading up to childbirth. Younger mothers are also at more risk for obstructed labor due to growth of the pelvis not being completed. (Sentence 4 - edit to clean up grammar). All of these mechanical factors lead to a failure to progress in labor.

Diagnosis

(Sentence 1). Ultrasound can be used to predict malpresentation of the fetus. In examination of the cervix once labor has begun, all examinations are compared to regular cervical assessments. The comparison between the average cervical assessment and the current state of the mother allows for a diagnosis of obstructed labor. An increasingly long time in labor also indicates a mechanical issue that is preventing the fetus from exiting the womb.

Treatment

Before considering surgical options, changing the posture of the mother during labor can help to progress labor. (Sentence 1- change "surgical opening" to name of procedure - symphysiotomy). Caesarean section is the invasive method but is often the only method that will save the lives of both the mother and the infant. Symphysiotomy is the surgical opening of the symphysis pubis. This procedure can be completed more rapidly than Caesarean sections and does not require anesthesia, making it a more accessible option in places with less advanced medical technology. This procedure also leaves no scars on the uterus which makes further pregnancies and births safer for the mother.Another important factor in treating obstructed labor is monitoring the energy and hydration of the mother. Contractions of the uterus require energy, so the longer the mother is in labor the more energy she expends. When the mother is depleted of energy, the contractions become weaker and labor will become increasingly longer. Antibiotics are also an important treatment as infection is a possible result of obstructed labor. (Delete Sentence 2).

Prognosis

(Sentence 1). (Sentence 2). Fetal death can be caused by asphyxia. Obstructed labor is the leading cause of uterine rupture worldwide. Maternal death can result from uterine rupture, complications during caesarean section, or sepsis.

Preventive Measures (new section)

Access to proper health services can reduce the prevalence of obstructed labor. Less developed areas have inadequate health services to attend to obstructed labor, resulting in a higher prevalence among less developed area. Improving nutrition of female, both before and during pregnancy, is important for reducing the risk of obstructive labor. Creating education programs about reproduction and increasing access to reproductive services such as contraception and family planning in developing areas can also reduce the prevalence of obstructed labor.

Epidemiology

(Sentence 1). Globally, obstructed labor accounts for 8% of maternal deaths.

Copy of Article

Obstructed labour

Obstructed labour, also known as labour dystocia, is when, even though the uterus is contracting normally, the baby does not exit the pelvis during childbirth due to being physically blocked. Complications for the baby include not getting enough oxygen which may result in death. It increases the risk of the mother getting an infection, having uterine rupture, or having post-partum bleeding. Long term complications for the mother include obstetrical fistula. Obstructed labour is said to result in prolonged labour, when the active phase of labour is longer than twelve hours.

The main causes of obstructed labour include: a large or abnormally positioned baby, a small pelvis, and problems with the birth canal. Abnormal positioning includes shoulder dystocia where the anterior shoulder does not pass easily below the pubic bone. Risk factors for a small pelvis include malnutrition and a lack of exposure to sunlight causing vitamin D deficiency. It is also more common in adolescence as the pelvis may not have finished growing. Problems with the birth canal include a narrow vagina and perineum which may be due to female genital mutilation or tumors. A partograph is often used to track labour progression and diagnose problems. This combined with physical examination may identify obstructed labour.

The treatment of obstructed labour may require cesarean section or vacuum extraction with possible surgical opening of the symphysis pubis. Other measures include: keeping the women hydrated and antibiotics if the membranes have been ruptured for more than 18 hours. In Africa and Asia obstructed labor affects between two and five percent of deliveries. In 2015 about 6.5 million cases of obstructed labour or uterine rupture occurred. This resulted in 23,000 maternal deaths down from 29,000 deaths in 1990 (about 8% of all deaths related to pregnancy). It is also one of the leading causes of stillbirth. Most deaths due to this condition occur in the developing world.

Cause

The main causes of obstructed labour include: a large or abnormally positioned baby, a small pelvis, and problems with the birth canal. Abnormal positioning includes shoulder dystocia where the anterior shoulder does not pass easily below the pubic bone. Risk factors for a small pelvis include malnutrition and a lack of exposure to sunlight causing vitamin D deficiency. while problems with the birth canal include a narrow vagina and perineum which may be due to female genital mutilation or tumors.

Diagnosis

Obstructed labour is usually diagnosed based on physical examination.

Treatment

The treatment of obstructed labour may require cesarean section or vacuum extraction with possible surgical opening of the symphysis pubis. Other measures include: keeping the women hydrated and antibiotics if the membranes have been ruptured for more than 18 hours.

Prognosis

If cesarean section is obtained in a timely manner, prognosis is good. Prolonged obstructed labour can lead to stillbirth, obstetric fistula, and maternal death.

Epidemiology

In 2013 it resulted in 19,000 maternal deaths down from 29,000 deaths in 1990.

Research for Obstructed Labour

1-Nutrition and Obstructed Labor:

https://watermark.silverchair.com/291s.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAjowggI2BgkqhkiG9w0BBwagggInMIICIwIBADCCAhwGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMGHmCLrltv44-hXVmAgEQgIIB7cgcJ3uIokWEtmCFRYSdLGYT4fcWk5_BYwRICW9-_6Z8dyIegSCnwuRcqhp1IfIhvAiHxYfKSLVGAERFsoZpzbysOshD-H4BHkrArWJ7d9HfYhUsQBiSxFRSzfxmxQ9s3OYwEAPCFS_QcCmMvgFOjfJ9HO4V31BqYYkINml73O_l7Ya3Epd-KC_9QgCaJBdJK3AiYqQr1hnfrmpEPQryPk8l9sz96M3UTcMmvvYOYeHmCHfZqXbeDi-Bp0yhvd0ZutLW099DSawvBWmN7_fprQcXxaZ6FlbjtF2BMpziRgku3qi4d51PfycM21c_MKp5O3wtrbSoxkwTblNCxNafFkZfe_SY3737lU5S7fxm5iBYXN35WBMenIWoHQ70srwGRZrRh022uS3WoqRqRXGK2vnCO4ttU624QxCtSINFDRqBI5n5rIb9VgelhB7cIhlCkGJQUCWP-N3RvC3Dv_9Mg6W9FR9UD0wWG4WrvhLKXCZdG2HCS7qXvfUxjKRtbKyJlN3dsSn9C0w32qbxkqYlbQ83Ruooxic0VjpbTSc8FgC134B3JWcT_A32FM8_uaw_tuDASoer7oOabAGuhI4E2yZmDYYwtNKnilxRRGFIENmTYynmbKG4_tjRxZbwGQvv5Hv3H9kcYtqKoCGCXRM

2-Evolutionary Origins of Obstructed Labor:

https://journals.lww.com/obgynsurvey/Fulltext/2007/11000/The_Evolutionary_Origins_of_Obstructed_Labor_.23.aspx

3-Using Better Technology to Reduce Mortality

https://obgyn.onlinelibrary.wiley.com/doi/full/10.1016/j.ijgo.2004.01.011

4-Reducing maternal death and disability during pregnancy

https://academic.oup.com/bmb/article/67/1/191/330404

5-Global burden of Obstructed Labor in the Year 2000

http://www.who.int/healthinfo/statistics/bod_obstructedlabour.pdf

6-WHO Analysis of Cause of Maternal Death

https://www.sciencedirect.com/science/article/pii/S0140673606683979

***Citation 3 is same as Citation 1 in original article