PIP: The major cause of obstructed labor is cephalopelvic disproportion, which may be due to a small pelvis, a large baby, fetal malpresentation, a tight perineum, or abnormalities or tumors of the uterus, ovary, or vagina. Prior to obstruction in primigravidae the rate of cervical dilation in the active 1st phase of labor slows to less than 1 cm/hr. If intervention is not done, fetal anoxia, pressure necrosis, fetal death, and vesicovaginal fistula will occur. In multigravidae the cervix may achieve full dilation, but the fetus fails to descend in the birth canal, and the uterine contractions continue until the uterus ruptures. The primary treatment for obstructed labor is prevention through adequate prenatal care. In communities without hospital facilities, midwife-run satellite clinics with adequate transport for referrals are the next best option. Another option is the provision of mothers' waiting areas near the clinic or hospital, where expectant mothers can receive intrapartum supervision. Labor should be monitored with a partogram, so that abnormal cervical dilation can be detected early, and the patient can be transferred to hospital. Once there, the patient will require immediate parental fluids and antibiotics before surgery. If an anesthetist is not available, the surgeon should administer an epidural block. A stomach tube and antacid premedication should be used to prevent aspiration of gastric contents. The surgeon must decide on the most apposite mode of delivery: episiotomy, ventouse and forceps delivery, symphysiotomy, or cesarean section. Various cesarean section methods may be appropriate: extraperitoneal cesarean section when there is intrauterine infection in cephalic presentation, De Lee incision where there is transverse cephalic presentation or an uncorrectable constriction ring, or lower segment transverse incision. If the fetus is dead and the uterus has not ruptured, vaginal destruction of the fetus is preferable to cesarean section. If the uterus has ruptured, cesarean hysterectomy is the recommended action. Cesarean section is the recommended procedure for vertex, brow, and transverse presentations if the fetus is alive. A live fetus with hydrocephaly may be delivered vaginally after the head is drained, but symphysiotomy may be required.