Of the 50 patients in the study group, 7 (14%) patients were diagnosed to have primary dysfunctional labour, 5 (10%) patients had secondary arrest of labour, whereas arrest of descent
in second stage occurred in 2 (4%) patients.
About a year ago, a longtime friend had her first baby, and required a cesarean for arrest of descent
. "She said, 'I cannot believe someone would cut me open and they're not even going to see me in 6 weeks,' " recalled Dr.
Cesarean delivery was indicated if at least one of the following was present: nonreassuring fetal status (persistent category II or III); active phase arrest of dilation; arrest of descent
in the second stage of labor; or failed induction of labor.
Taking into account "decision to incision" time, these waiting periods appear shorter than the American College of Obstetricians and Gynecologists guidelines, which define arrest of descent
as greater than 3 hours in nulliparous women with epidural analgesia and greater than 2 hours in multiparous women with epidural analgesia, the investigators reported online ahead of print in the American Journal of Obstetrics and Gynecology (2010 [doi: 10.1016/j.ajog.2010.06.058]).
He says that when performing a cesarean section for arrest of descent
with a well-engaged fetal head and no one available to lend "a vaginal hand," after making the uterine incision but before placing your hand in the incision, first cup the fetal head outside over the lower uterine segment and lift to disengage the head, breaking the vacuum and making delivery much easier.