A primipara with a breech presentation is in the second stage of labor for 2 hours. The fetal heart rate is 140 beats per minute. She is getting 3 uterine contractions per 10 minutes. The breech is felt at the level of the ischial spines. The membranes are absent. The pelvis is adequate. The estimated fetal weight is 3 kg.What is the most appropriate management?
Ans. is d, i.e. Perform a lower segment cesarean sectionIn the question patient is a primigravida,She is in 2nd stage of labor for 2 hours with breech, i.e. it is a case of prolonged second stage of labor.In case of breech, as discussed in the text,In prolonged second stage, it is not advisable to rupture membranes due to the risk of cord prolapse and not by oxytocin because strong contractions produced by oxytocin can cause descent of soft breech even, if there is fetopelvic disproportion with resultant difficulty in delivery of fetal head.In case of breech, delay in 1st or 2nd stage is regarded as a sign of fetopelvic disproportion and requires cesarean section.
Commence an infusion of oxytocin
Improve maternal hydration with intravenous fluids
Observe for a further period of 1 hour for spontaneous delivery to occur
Perform a lower segment cesarean section
Malpresentation