Protraction and arrest disorders Quiz: Ace Your Exams
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A 27-year-old woman, gravida 2, para 1, at 39 weeks of estimated gestational age (EGA), presents to the hospital in labor with grossly ruptured membranes. Her pregnancy is complicated by gestational diabetes mellitus (GDM), well-controlled with diet. Growth ultrasound at 36 weeks EGA showed an estimated fetal weight (EFW) at the 48th percentile. Her last pregnancy resulted in an uncomplicated spontaneous vaginal delivery at term. On exam, vital signs are within normal limits, the cervix is visually dilated 4 cm, and the fetal heart rate pattern is Category I. Over the next 10 hours, she gets an epidural and progresses to 7 cm dilation, 80% effacement, and -1 cm station, with the fetus in a right occiput transverse (ROT) position. Temperature is 38.9°C (102°F), pulse is 112/min, respirations are 20/min, and blood pressure is 128/85 mmHg. Baseline fetal heart rate is 190 bpm, with moderate variability and intermittent variable decelerations. The patient is started on appropriate treatment. Two hours later, her cervical exam is unchanged. An abnormality in which component of labor is most likely causing her protracted labor course, and what is the best management at this time?
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