Protraction and arrest disorders Quiz: Ace Your Exams

A 28-year-old primigravid woman presents to Labor & Delivery (L&D) at 41 weeks of estimated gestational age (EGA) with regular, painful contractions for the past 2 hours. Her pregnancy has been uncomplicated, and past medical history is non-contributory. Vital signs are stable and within normal limits. On exam, the cervix is 3 cm dilated, 50% effaced, with the fetus palpable at -3 cm station, with intact fetal membranes. A bedside ultrasound confirms that the fetus is in a vertex presentation with adequate amniotic fluid. A non-stress test (NST) demonstrates contractions every 2 to 4 minutes, a baseline fetal heart rate of 150 with moderate variability, two accelerations, and no decelerations. The patient walks for 2 hours, and on repeat exam, the cervix has progressed to 5 cm dilated, 50% effaced, and -2 cm station. She is admitted to the hospital and contractions continue every 2 to 3 minutes. An epidural is placed per the patient’s request. Four hours later, the cervix is unchanged, though the fetal heart rate pattern remains reassuring. The patient inquires about the need for a cesarean delivery (CD). Which of the following should be discussed with the patient?