Cesarean Section Indications

A 28-year-old primigravida at 39 weeks of gestation presents to the labour ward with regular uterine contractions. On examination, cervical dilation is 3 cm, and the fetal head is at −2 station. Fetal heart rate is 140 bpm with normal variability. After 6 hours of augmentation with oxytocin, cervical dilation remains 3 cm with no descent of the fetal head. Pelvic assessment suggests adequate pelvic dimensions. What is the most appropriate next step in management?

A 32-year-old primigravida at 38 weeks gestation presents with sudden onset of painless vaginal bleeding. On examination, the uterus is soft and non-tender. Fetal heart rate is 140 bpm. Which is the investigation of choice to confirm the diagnosis before proceeding to cesarean section?

A 32-year-old G2P1 at 38 weeks of gestation presents with vaginal bleeding and abdominal pain. On examination, blood pressure is 110/70 mmHg, pulse 98 bpm, and the abdomen is tender with mild rigidity. Speculum examination shows blood in the vagina but no cervical lesions. Ultrasound reveals a placenta covering the internal cervical os with 2 cm of placental tissue overlying the os. Fetal heart rate is 145 bpm. What is the most appropriate management?

A 28-year-old G2P1 at 37+2 weeks gestation with a previous history of one lower segment cesarean section (LSCS) for cephalopelvic disproportion presents in active labour. Cervical examination reveals 6 cm dilation, 90% effaced, and the fetal head at −1 station. Fetal heart rate is 136 bpm with good variability and accelerations. The patient desires a trial of vaginal delivery after cesarean (TOLAC). What is the most appropriate next step in management?

A 32-year-old multigravida at 38 weeks gestation with a previous cesarean section for cephalopelvic disproportion now presents in active labor. Partograph shows arrest of dilation at 6 cm for 4 hours despite adequate uterine contractions. Which feature best distinguishes cephalopelvic disproportion from uterine inertia as the indication for repeat cesarean section?