A 26-year-old primigravida at 41 weeks of gestation is being induced with dinoprostone gel. She is in active labor; cervix is 6 cm dilated, fully effaced, and the head is at 0 station. Over the next 2 hours, there is no further cervical dilation. CTG shows category II tracing. Which of the following best describes this pattern?

• A Active phase arrest; cesarean section indicated immediately
• B Normal progress; re-evaluate in 4 hours
• C Secondary arrest; perform operative vaginal delivery
• D Protracted active phase; augment with oxytocin ✓

Explanation

Active phase arrest in a primigravida is defined as no cervical change over 4 hours with adequate contractions, or 6 hours with inadequate contractions. At 2 hours of no progress in active labor, this represents a protracted active phase. Before diagnosing arrest, uterine activity should be assessed; if contractions are inadequate (<200 Montevideo units), augmentation with oxytocin is appropriate. Cesarean section is premature at this stage without a trial of oxytocin augmentation.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.