1st stage	No enough contractions	Oxytocin
	Enough contractions	CS
2nd stage	Cvx fully dilated	Operative vaginal delivery
	No baby descent	CS

⤴️ Latent	Prima >20 h Multigravida >14 h	·       Sedation, ·       unfavorable Cvx, ·       weak uterus contractions	Tx: ·       rest and hydration. ·       Most will convert to spontaneous delivery in 6 to 12 hours.
Slow cvx dilation	Very slow cvx dilation during ACTIVE phase of Labor ·       <1.2 /h in PG ·       <1.5 /h in MG	3 Ps (Power, Passenger, Passage)	CS
❌ Cx dilation	2h	·       Cephalopelvic disproportion  (baby is bigger than pelvis) ·       Excessive sedation	CS
❌ baby descent	1h	·       Cephalopelvic disproportion  (baby is bigger than pelvis ·       Excessive sedation	CS

	Oxytocin
Indications	·        IOL ·       Prevents & Tx PPH
SE	·        ⤵️ Na ·       Hypotension ·       Tachysystole

	Second stage arrest of labor
Def	·       Full Cervix dilation ·       الطفل مب جالس ينزل ·       ≥3 hours if nulliparous ·       ≥2 hours if multiparous
RF	·       Maternal obesity ·       DM ·       Excessive pregnancy weight gain
Why?	·       Cephalopelvic disproportion ·       الطفل رأسه كبير، أو الرحم ضيّق ·       Malposition ·       Inadequate contractions ·       Maternal exhaustion
Tx	·       Operative vaginal delivery ·       Cesarean delivery

	Operative vaginal delivery (vacuum/forceps)
Indications	·       Protracted 2nd stage of labor ·       Fetal heart rate abnormalities ·       Maternal contraindications to pushing
Fetal Comp	·       Laceration ·       Cephalohematoma ·       Facial nerve palsy ·       Intracranial hemorrhage ·       Shoulder dystocia
Mom Comp	·       GU tract injury ·       Urinary retention ·       Hemorrhage