Management of Arrested Labor in a Primigravida at 38 Weeks Gestation

Assessment and Diagnosis

• The American College of Obstetricians and Gynecologists recommends that a patient with arrested labor despite adequate contraction strength should be assessed for active phase arrest, defined as no cervical change despite adequate uterine contractions, with a normal fetal heart rate tracing 1, 3
• A cervical examination showing 8 cm dilation, 90% effacement, with the head at 0 station is consistent with active phase arrest 2

Management Algorithm

• The American College of Obstetricians and Gynecologists recommends oxytocin augmentation as the first-line treatment for active phase arrest when cephalopelvic disproportion (CPD) is not evident, with a success rate of 92% for vaginal delivery 1, 2, 3
• Assessing for CPD, which occurs in 25-30% of active phase arrest cases, is crucial before oxytocin augmentation 3, 4

Important Considerations

• The American College of Obstetricians and Gynecologists recommends monitoring fetal heart rate closely during oxytocin administration to detect any signs of distress, and discontinuing oxytocin immediately if signs of fetal distress or uterine hyperactivity occur 1, 2, 3, 4
• If no progress occurs after 4 hours of adequate oxytocin augmentation, reassess for CPD, and consider cesarean delivery if evidence of CPD emerges 2, 4