A primigravida with full term pregnancy in labor for 1 day is brought to casualty after dia handing. On examination she is dehydrated, slightly pale, bulse 100/min, BP120/80 mm Hg. abdominal examination reveals a fundal height of 36 weeks, cephalic presentation, foetal heart absent, mild uterine contractions present. On P/V examination, cervix is fully dialted, head is at +1 station, caput with moulding present, pelvis adequate. Dirty, infected discharge is present. What would be the best management option after initial work-up?
Well friends lets first analyse the condition of patient and then think about its management:

Patient is primigravida
On examination:

– Dehydration is present
– P/R is 100/min, i.e. tachycardia present.
PIA

Fundal height-36 weeks
Presentation-cephalic
FHS-Absent
Mild uterine contractions are present.

P/V

Cervix-fully dilated
Station = + 1
Caput present
Moulding present
Dirty infected discharge is present.

Most importantly–Pelvis is adequate.
This patient is undoubtedly a case of obstructed labour. As we all know in nulliparous females in case of obstructed labour— a state of uterine exhaustion is reached manifested as weakened uterine conditions.

In such cases, if oxytocin drip is given it may lead to rupture of uterus as lower segment is thinned out (i.e. option ‘b’ ruled out).
Craniotomy and other destructive procedures are not carried out in modern obstetrics (i.e., option ‘d’ ruled out).

Mgt: of obstructed labor cesarean section
Cesarean section
Oxytocin drip
Ventouse delivery
Craniotomy and vaginal delivery