Question
A 37-week primigravida has experienced mild labor pains for 20 hours. Examination reveals her cervix remains dilated at 1 cm with no effacement. What would be the most appropriate course of action for managing this labor?
| A. |
Sedation and waiting
|
| B. |
Augmentation with oxytocin
|
| C. |
Cesarean section
|
| D. |
Amniotomy
|
Show Answer
|
Correct Answer » B
Explanation
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|
- The patient has prolonged latent phase of labor with inadequate uterine contractions.
- Modern obstetric management, including ACOG-based labor management principles, favors augmentation of labor when contractions are ineffective and labor is prolonged.
- Oxytocin augmentation helps establish effective uterine contractions and progression into active labor.
- A prolonged latent phase alone is not an indication for cesarean section.
Why Other Options are Incorrect
A. Sedation and waiting
- This was the traditional management in older obstetric textbooks.
- Therapeutic rest and sedation were previously recommended for prolonged latent phase.
- However, current evidence-based practice favors active management with augmentation once true labor is established and contractions are inadequate.
C. Cesarean section
- There is no indication for cesarean delivery:
- No fetal distress
- No obstructed labor
- No cephalopelvic disproportion
- No failed active phase
- ACOG recommends avoiding cesarean section for prolonged latent phase alone.
D. Amniotomy
- Artificial rupture of membranes alone is less effective at 1 cm dilatation with an uneffaced cervix.
- Amniotomy is more useful after adequate cervical ripening or in established labor.
- Oxytocin augmentation is more appropriate in this situation.
