Question

You are examining a multigravida in the second stage of labor for the past two hours. On examination, contractions are adequate, the cervix is dilated with the head at station 0 with molding 2+ and caput 2+. The sagittal suture is in the right occipitotransverse position. The fetal heart rate is 140 beats / minute. Which of the following is carried out for the management of this patient? 

• A. Midpelvic forceps
• B. Vacuum -assisted delivery
• C. Wait for an hour for spontaneous labor
• D. Lower segment cesarean section

Answer 1

The Correct Option is D

In the scenario described, the patient is a multigravida (a woman who has been pregnant more than once) in the second stage of labor for two hours. Here are the clinical findings: contractions are adequate, the cervix is fully dilated, the fetal head is at station 0 with molding 2+ and caput 2+, and the sagittal suture is in the right occipitotransverse position. The fetal heart rate is within normal limits at 140 bpm.

The options for management are:

• Midpelvic forceps
• Vacuum-assisted delivery
• Wait for an hour for spontaneous labor
• Lower segment cesarean section (LSCS)

Analysis:
The second stage of labor is the phase from full cervical dilatation to the delivery of the baby. The position of the fetal head is key to progressing labor. In this case, the fetal head is at station 0, indicating that it is engaged but not yet descended into the birth canal. The molding (2+) and caput succedaneum (caput 2+) suggest prolonged labor with some degree of pressure on the fetal head, which could lead to complications if labor continues without progress.

The fetal position being right occipitotransverse is not ideal for spontaneous delivery, as optimal delivery positions are generally occipitoanterior. Additionally, the fact that the fetal head hasn't further descended despite adequate contractions increases concern for cephalopelvic disproportion (CPD), where the baby's head is too large for the mother's pelvis.

Recommended Management: Considering these factors, proceeding with a lower segment cesarean section (LSCS) is the safest option for both mother and baby. This approach minimizes the risk of fetal distress and maternal complications. Attempting instrumental delivery (forceps or vacuum) or waiting longer may not be advisable due to the baby's position and the signs of molding and caput.

Therefore, the correct course of action is: Lower segment cesarean section.