In the management of second stage arrest, a patient is fully dilated at 9 cm, has been pushing for 3 hours with epidural anesthesia, and the fetal head is at +2 station in OA position. The safest next step is:

• A Immediate cesarean delivery for failed second stage
• B Continue pushing for additional 1 hour, reassess
• C Operative vaginal delivery (OVD) by experienced operator ✓
• D Reduce epidural rate and reassess in 30 minutes

Explanation

With the fetal head at +2 station in OA position, the conditions are favorable for operative vaginal delivery (vacuum or forceps) by an experienced operator, which is safer than cesarean delivery at advanced station. ACOG guidelines define prolonged second stage in a nullipara with epidural as >4 hours; this patient at 3 hours is approaching but has not yet met criteria for abnormal second stage, and fetal descent to +2 is encouraging. OVD at +2/+3 OA has low complication rates. Cesarean at +2 station (high cesarean) carries significant maternal morbidity. The decision requires maternal and fetal assessment—if reassuring FHR and good maternal effort, OVD is appropriate.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.