A primigravida at 41 weeks is in active labour. After 4 hours at 7 cm dilation with adequate uterine contractions (275 Montevideo units) and ruptured membranes, cervical examination shows no change. According to ACOG 2014 redefined guidelines, what is the correct diagnosis and the next appropriate step?

• A Prolonged latent phase; therapeutic rest with sedation
• B Protracted active phase; expectant management with oxytocin titration
• C Active phase arrest; cesarean delivery ✓
• D Second stage arrest; operative vaginal delivery

Explanation

Under ACOG/NICHD 2014 guidelines, active phase arrest is defined as no cervical change for ≥4 hours at ≥6 cm dilation with adequate uterine contractions (≥200 MVUs) and ruptured membranes. This patient meets all criteria (7 cm, 4 hours, 275 MVUs, ruptured membranes). The diagnosis is active phase arrest, and the recommended management is cesarean delivery. The older Friedman criterion of 2 hours is no longer used.

Reference: Williams Obstetrics / ACOG Practice Bulletin 146 (Reaffirmed), 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.