A primigravida in active labour is noted to have arrest of active phase — no cervical change for 4 hours with adequate contractions (>200 Montevideo units). She is at 7 cm with intact membranes. The fetal head is at station 0 in OA position. What is the MOST appropriate next management step?

• A Immediate caesarean section for active phase arrest
• B Administration of tocolytics
• C Augmentation with oxytocin after amniotomy ✓
• D Reassess in 2 hours without intervention

Explanation

Active phase arrest (no progress for ≥4 hours with adequate contractions, or ≥6 hours with inadequate contractions) warrants augmentation. With intact membranes, amniotomy is performed first, followed by oxytocin augmentation if contractions are inadequate or as primary augmentation. ACOG recommends allowing adequate trial of labour augmentation before proceeding to caesarean section, as most will deliver vaginally. Tocolytics are contraindicated in active labour.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.