Snap Shot A 33-year-old G4P3 presents at 41 weeks gestation in labor. She has been dilated to 10 cm and fully effaced for the past 2 hours but has not yet delivered. Introduction Stoppage of the normal progression of labor caused by problems with the 3 P's pelvis - inadequate size, shape passenger - excessive fetal size, abnormal position, presentation or lie power - inadequate/hypotonic uterine contractions most common cause There are 2 main types Stage 1 (dilation) active phase arrest cervix is dilated to > 3 cm prolonged if cervical dilation is < 1.2 cm/hour (primipara) or 1.5 cm/hour (multipara) arrest if no cervical change in > 2 hours Stage 2 (descent) arrest unsuccessful delivery of fetus in > 2 hours of pushing at 10 cm (complete) dilation (primipara) or 1 hour (multipara) > 3 hours if patient has an epidural Stage 3 (expulsion) arrest failure to delivery the placenta within 30 minutes ddx includes placenta accreta, increta, or percreta Evaluation Intrapartum assessment cervical exam to asses for stage 1 arrest clinical observation to asses for stage 2 arrest Treatment stage 1 arrest amniotomy possible management, though less commonly used IV oxytocin - if hypotonic contractions increases contraction strength and frequency administer until contractions deemed adequate by frequency, intensity and duration measures morphine if hypertonic contractions cesarean section if adequate contractions if mother does not respond to oxytocin stage 2 arrest IV oxytocin if contractions are inadquate assisted delivery (vacuum, forceps) if contractions adequate and fetus is low in the pelvis (> 0 station) cesarean section if contractions adequate and fetus is high in the pelvis ( < 0 station) stage 3 arrest IV oxytocin manual removal (if IV oxytocin fails) hysterectomy may be needed in emergency situations with extreme bleeding Prognosis, Prevention, and Complications Increased risk of ascending infection with prolonged labor