A woman is in active labour at 8 cm dilatation. Partograph shows cervical dilatation has crossed the action line. She has had adequate uterine contractions (4 in 10 minutes, each lasting >45 seconds). The fetal head is at station -1. What does crossing the action line mandate?
- A Immediate caesarean section for failure to progress
- B Immediate review, assess cause, and consider augmentation or operative delivery ✓
- C Reassess in 2 hours before any intervention
- D Amniotomy if membranes are intact
Correct answer: B. Immediate review, assess cause, and consider augmentation or operative delivery
Explanation
Crossing the action line on the WHO partograph indicates abnormal progress and mandates immediate medical review to determine the cause (inadequate contractions, cephalopelvic disproportion, malposition). Management depends on the cause: if contractions are inadequate, augmentation with oxytocin is appropriate; if CPD or obstruction is present, cesarean section is indicated. Action line crossing does not automatically mandate cesarean — assessment of cause is the first step.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.