Management of Arrested Labor in a Primigravida at 38 Weeks Gestation

Assessment of Current Labor Status

The American College of Obstetricians and Gynecologists recommends that a patient with spontaneous rupture of membranes and painful contractions at 38 weeks gestation should be assessed for labor progression, with a current cervical examination showing 8 cm dilation, 90% effacement, head at 0 station 2
Contraction strength is adequate at 200 Montevideo units every 10 minutes, indicating active labor 1
After 4 hours, the cervical examination is unchanged, indicating arrest of active phase labor, with fetal heart rate tracing showing normal fetal well-being 2

The American College of Obstetricians and Gynecologists suggests assessing for cephalopelvic disproportion (CPD), which occurs in 25-30% of active phase labor abnormalities, with consideration of other factors such as fetal macrosomia, malposition, excessive analgesia, or insufficient uterine contractility 1, 3
In this case, estimated fetal weight is not macrosomic, with an estimated weight of 3600g (8 lb) 3

If no progress occurs after 4 hours of adequate oxytocin augmentation, reassess for CPD, with the American College of Obstetricians and Gynecologists recommending discontinuation of oxytocin if signs of uterine hyperstimulation or fetal distress develop 1, 2
The American College of Obstetricians and Gynecologists recommends proceeding to cesarean delivery if evidence of CPD emerges during augmentation 3

The American College of Obstetricians and Gynecologists recommends maintaining intrauterine pressure catheter to ensure adequate contractions, with serial cervical examinations to evaluate progress 1, 4