A primigravida in 2nd stage of labour for past 1hr,with the fetus in left occipito transverse position at station +++1.The best way to manage would be :
Reference:Dutta pg 398
This is a case of transverse arrest.
The head is still at +1(what is +++1???),that means it still has not crossed the ischial spines.
She is in 2nd stage,that means cervix is fully dilated;
So overall we have a case of primi with full dilatation of cervix,in active labour pains but the head not descending;
and 1 hour has passed already;
with PV findings telling us fetus is in occipito transverse position.
In deep transverse arrest,the head is deep into the cavity;
the saggital suture is placed in the transverse bispinous diameter &
there is no progress in descent of the head even after ½-1hr following full dilatation of the cervix.
Dutta further says,
the pelvis should be assessed and
if,pelvis is adequately spacious &
fetus of normal size(not BIG baby) &
fetal conditions adequate for a vaginal delivery, ventouse is ideal in these cases.
Since,nothing is mentioned about inadequacy of the pelvis,nor the mention about fetal distress,
I take that these things are normal(& the main concern being,why the labour isnt progressing inspite of normality of every other thing!!!)
a)apply vacuum :ideal for this case;correct choice!
b)apply forceps : applied only after manual rotation is done.
c)watchful expectancy : DTA cases wont deliver spontaneously;and we have already waited for 1 hour!!!
d)emergency LSCS : undertaken when pelvis is inadequate
Correct choice: (a) apply vacuum
Source of this Question: RxPG DNB 2004
Author : Dr. Rashmi Yadav
Publisher: Jaypee Brothers Medical Publishers, India
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