Home › MCQs › Nursing › Question #9134
Back to Questions
Nursing QUESTION #9134
Question 1
A gravida 2 para 1 at 39 weeks presents in active labor. Vaginal examination reveals: cervix 8 cm dilated, fully effaced, vertex at +1 station, occiput posterior position. After 2 hours, no progress is noted. What is the MOST likely cause of arrest of descent?
  • Cephalopelvic disproportion (CPD)
  • Occiput Posterior (OP) position causing malrotation✔️
  • Inadequate uterine contractions (hypotonic labor)
  • Cord prolapse
Correct Answer Explanation

Persistent Occiput Posterior (POP) position is a common cause of prolonged second stage and arrest of descent. In OP position:

  • The fetal head presents with a larger diameter to the pelvis: occipito-frontal diameter \(\approx 11.5\,\text{cm}\) vs. sub-occipito-bregmatic \(9.5\,\text{cm}\) in OA
  • Internal rotation from OP to OA requires \(135°\) rotation (vs. \(90°\) from OT, \(45°\) from OA)
  • Causes: anthropoid/android pelvis, deflexed head

Management options:

  • Manual rotation to OA (Barton's maneuver)
  • Expectant management if maternal/fetal condition good
  • Instrumental delivery: forceps (Kielland's rotational forceps) or rotational vacuum
  • Cesarean section if rotation fails or fetal distress

CPD is less likely in a multigravida who delivered previously without CPD. Hypotonic labor would show weak contractions on partograph/CTG.