Labour and delivery: deep transverse arrest: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Labour and delivery: deep transverse arrest

Sample item

A nulliparous woman has been pushing for 2 hours. The head is at station 0 to +1 with the sagittal suture in the transverse diameter, no rotation despite adequate contractions, and the ischial spines are prominent with a narrow subpubic arch. The fetal heart rate is normal. What is the most appropriate management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Rotation by an expert, or caesarean section

Deep transverse arrest occurs when the head fails to rotate in a mid-cavity that is narrowed by an android pelvis. Options are manual rotation, Kielland forceps or caesarean section, chosen by the operator's skill, and traction without rotation risks injury. Fundal pressure and prolonged pushing are not recommended.

Option by option

  • A. Emergency symphysiotomy at the bedside

    Symphysiotomy is a rarely used procedure for low-resource settings and does not correct arrest of rotation.

  • B. Mid-cavity ventouse traction without any rotation

    Traction with ventouse without rotating the head risks failure and fetal injury.

  • C. Rotation by an expert, or caesarean section (correct)

    Correct. Rotation by a skilled operator or caesarean birth overcomes the arrest of rotation.

  • D. Fundal pressure and continued pushing for 2 more hours

    Fundal pressure and prolonged pushing will not rotate a head in a narrowed mid-cavity and risk trauma.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More OBG questions

Questions about this OBG question

What is the answer to this OBG question?

The best answer is C, Rotation by an expert, or caesarean section. Deep transverse arrest occurs when the head fails to rotate in a mid-cavity that is narrowed by an android pelvis.

Why is "Emergency symphysiotomy at the bedside" not the answer?

Symphysiotomy is a rarely used procedure for low-resource settings and does not correct arrest of rotation.

Why is "Mid-cavity ventouse traction without any rotation" not the answer?

Traction with ventouse without rotating the head risks failure and fetal injury.

Why is "Fundal pressure and continued pushing for 2 more hours" not the answer?

Fundal pressure and prolonged pushing will not rotate a head in a narrowed mid-cavity and risk trauma.

What concept does this question test?

It tests Labour and delivery: deep transverse arrest in OBG. Options are manual rotation, Kielland forceps or caesarean section, chosen by the operator's skill, and traction without rotation risks injury. Fundal pressure and prolonged pushing are not recommended.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Labour and delivery: deep transverse arrest?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.