Dystocia: The Daily PANCE Blueprint

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Dystocia: The Daily PANCE Blueprint

A 39-year-old G2P1 woman at 40 weeks gestation presents in active labor. She has made minimal cervical change after 4 hours despite adequate contractions. Fetal heart tracing shows persistent late decelerations. Which of the following is the most appropriate next step in management?

A. Amniotomy
B. Oxytocin augmentation
C. Prostaglandin F2-alpha
D. Vacuum-assisted delivery
E. Cesarean delivery

Answer and topic summary

The answer is E. Cesarean delivery

This patient has protracted labor with an inadequate cervical response despite adequate contractions, along with concerning fetal heart rate decelerations. This indicates the need for prompt delivery due to the high risk of fetal distress. Vacuum-assisted delivery is contraindicated with fetal distress. Therefore, cesarean delivery is the most appropriate next step in management.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Reproductive System ⇒ Complicated Pregnancy ⇒ Dystocia

Also covered as part of the Women's Health EOR topic list

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