Labour and delivery: secondary arrest in active phase: 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: secondary arrest in active phase

Sample item

A primigravida at term has been in labour for 14 hours. The cervix has remained at 6 cm for 5 hours despite adequate contractions on an oxytocin infusion. The head is high with marked caput and 3+ moulding, and the fetal heart tracing is normal. What is the best management?

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

The answer and the reasoning

D. Caesarean section

Arrest of dilatation despite adequate contractions with a high head, marked caput and severe moulding indicates cephalopelvic disproportion. Further oxytocin or waiting risks obstructed labour and uterine rupture, so delivery is by caesarean. Instrumental delivery is impossible with a high head and unfully dilated cervix.

Option by option

  • A. Mid-cavity forceps delivery

    The cervix is only 6 cm dilated and the head is high, so forceps cannot be applied.

  • B. Wait for 4 more hours and review

    Further waiting is unsafe because arrest with disproportion will not resolve.

  • C. Increase the oxytocin dose further

    More oxytocin in disproportion increases the risk of uterine rupture and fetal injury.

  • D. Caesarean section (correct)

    Correct. Failed progress in spite of good contractions, caput and severe moulding signals disproportion, requiring caesarean birth.

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 D, Caesarean section. Arrest of dilatation despite adequate contractions with a high head, marked caput and severe moulding indicates cephalopelvic disproportion.

Why is "Mid-cavity forceps delivery" not the answer?

The cervix is only 6 cm dilated and the head is high, so forceps cannot be applied.

Why is "Wait for 4 more hours and review" not the answer?

Further waiting is unsafe because arrest with disproportion will not resolve.

Why is "Increase the oxytocin dose further" not the answer?

More oxytocin in disproportion increases the risk of uterine rupture and fetal injury.

What concept does this question test?

It tests Labour and delivery: secondary arrest in active phase in OBG. Further oxytocin or waiting risks obstructed labour and uterine rupture, so delivery is by caesarean. Instrumental delivery is impossible with a high head and unfully dilated cervix.

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: secondary arrest in active phase?

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.