A 28-year-old primigravida at 39 weeks has been pushing for 3 hours without epidural analgesia. Cervix is fully dilated, vertex at +2 station, OA position, with moderate caput. CTG shows recurrent late decelerations. Which is the MOST appropriate management?

• A Continue expectant management for one more hour
• B Administer intravenous terbutaline tocolysis
• C Start oxytocin augmentation
• D Operative vaginal delivery if conditions met, otherwise cesarean ✓

Explanation

In a primigravida without epidural, the second stage should not exceed 3 hours. She has reached this limit with non-reassuring fetal status (recurrent late decelerations). The appropriate response is expedited delivery, either by forceps or vacuum if operative criteria are met, or cesarean if they are not. Oxytocin will not resolve the problem and may worsen fetal compromise. Tocolysis is inappropriate in the second stage with an abnormal CTG.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.