The partograph has a 'action line' drawn 4 hours to the right of the 'alert line.' When cervical dilatation reaches the action line in active labor, what is the recommended response?

• A Immediate cesarean section
• B Administer prophylactic antibiotics and continue monitoring for 2 more hours
• C Perform amniotomy as the sole intervention
• D Full reassessment and decision to augment, transfer to higher level of care, or perform operative delivery if appropriate ✓

Explanation

The alert line on the WHO partograph represents the 1 cm/hour minimum expected rate of cervical dilatation. The action line is drawn 4 hours to the right; reaching it indicates labor has been slower than expected for 4 hours. On reaching the action line, a full clinical reassessment is mandatory: assess maternal and fetal condition, reason for slow progress (power, passenger, pelvis), and decide on augmentation (oxytocin/amniotomy if appropriate), transfer to surgical facility if needed, or operative delivery. It does not mandate immediate cesarean — the cause must be assessed.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.