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