RxPG - Deep Transverse Arrest!

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 :

a)apply vacuum
b)apply forceps
c)watchful expectancy
d)emergency LSCS

Reference:Dutta pg 398

Quality:Thinker

Discussion:

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.

Dutta says,
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 isn’t progressing inspite of normality of every other thing!!!)

Explanation:

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

------------------------------------------------
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