# A nurse is assessing a multigravida client at 39 weeks gestation who has been in active labor for 12 hours. The nurse notes that cervical dilation has remained at 6 cm for the past 4 hours despite adequate uterine contractions occurring every 2-3 minutes lasting 60-90 seconds. Which assessment finding would be the priority concern indicating potential dystocia? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=543051 > language: ko > subject: Maternal Newborn Health ## 문제 A nurse is assessing a multigravida client at 39 weeks gestation who has been in active labor for 12 hours. The nurse notes that cervical dilation has remained at 6 cm for the past 4 hours despite adequate uterine contractions occurring every 2-3 minutes lasting 60-90 seconds. Which assessment finding would be the priority concern indicating potential dystocia? ## 보기 1. Lack of cervical dilation progress over 4 hours with adequate contractions **✔ 정답** 2. Maternal temperature of 99.2°F (37.3°C) after 12 hours of labor 3. Fetal heart rate baseline of 135 bpm with moderate variability 4. Maternal blood pressure of 128/82 mmHg during contractions **정답: 1** ## 해설 Lack of cervical dilation progress despite adequate contractions is the classic sign of dystocia, indicating arrest of dilation. This requires immediate intervention to prevent maternal and fetal complications. Other findings (mild fever, normal FHR, stable BP) are less urgent concerns in this context. ## 심화 해설 Understanding Labor Dystocia Labor dystocia, often described as difficult or abnormally slow labor, is a critical concept for NCLEX-RN preparation. It represents a significant deviation from the expected progression of labor and is a leading indication for cesarean delivery. The provided evidence highlights that dystocia during the active first stage of labor (AFSOL) is a major contributor to maternal and neonatal morbidity and mortality worldwide, making its prompt recognition a high-priority nursing responsibility [1]. Analyzing the Clinical Scenario The client is a multigravida at term in active labor for 12 hours. The critical assessment finding is that cervical dilation has arrested at 6 cm for 4 hours. This occurs in the context of adequate uterine contractions, defined as occurring every 2-3 minutes and lasting 60-90 seconds. The combination of adequate contractions with a lack of cervical change is the hallmark of active phase arrest, a primary form of labor dystocia. The research emphasizes that identifying predictors of AFSOL is crucial for timely intervention to prevent adverse outcomes [1]. Why the Correct Answer is the Priority The correct answer, Lack of cervical dilation progress over 4 hours with adequate contractions, is the priority concern because it directly defines a pathological state. In the active phase of labor, the cervix is expected to dilate at a minimum rate. An arrest of dilation for 4 hours or more in the presence of a sufficient uterine contractile pattern signals a mechanical or functional problem that prevents descent and dilation. This condition, known as active phase arrest, is a direct indicator of dystocia and necessitates immediate evaluation for potential interventions, such as amniotomy, oxytocin augmentation, or operative delivery, to mitigate risks to both the laboring mother and the fetus [1]. Why the Other Options Are Not the Priority The other findings, while requiring nursing assessment, do not represent the most immediate threat indicative of dystocia in this specific context. - **Maternal temperature of 99.2°F (37.3°C):** This is a low-grade elevation that can be common during prolonged labor due to exertion, dehydration, or epidural anesthesia. While it warrants monitoring for infection (chorioamnionitis), it is not a defining criterion for dystocia itself. - **Fetal heart rate baseline of 135 bpm with moderate variability:** This is a reassuring fetal heart rate tracing. Moderate variability and a normal baseline rate indicate a well-oxygenated fetal central nervous system. This finding is normal and expected. - **Maternal blood pressure of 128/82 mmHg during contractions:** A slight, transient elevation in blood pressure during the pain of a contraction is a normal physiological response. This reading is within acceptable limits and is not a primary indicator of a labor disorder. Nursing Implications for NCLEX-RN For the NCLEX-RN, you must be able to differentiate between expected findings in labor and those that signal a complication. The priority assessment for suspected dystocia is the pattern of cervical dilation in relation to uterine activity. The study from Ethiopia underscores that many determinants of AFSOL are potentially modifiable and context-specific, reinforcing the nurse's role in early identification and advocacy for timely management to reduce the risk of rising cesarean delivery rates and associated morbidity [1]. When analyzing a question, always link the pathophysiology—in this case, the failure of the cervix to yield to coordinated uterine forces—to the most definitive clinical sign, which is the arrest of dilation. References (research sources) - [1]Incidence and predictors of dystocia during the active first stage of labor among mothers at Debre Markos Comprehensive Specialized Hospital, Amhara, Northwest Ethiopia.Research articleKebede TN, Azanaw G, Mihret MS. (2025) · DOI: 10.1186/s12884-025-08192-w ## 임상 시나리오 Clinical Practice Guide: Labor Dystocia Assessment Labor dystocia, or abnormal labor progression, is a leading indication for cesarean delivery. Prompt recognition and intervention are essential to reduce maternal and neonatal morbidity. The key diagnostic criterion for active phase arrest is no cervical change for 4 hours or more in the presence of adequate uterine contractions, or for 6 hours or more with inadequate contractions. Nursing Assessment Priorities - Evaluate the labor curve (partograph) to identify a protraction or arrest pattern in cervical dilation and fetal descent. - Assess contraction frequency, duration, and intensity via palpation or intrauterine pressure catheter (IUPC). Adequate contractions are typically every 2-3 minutes, lasting 60-90 seconds, generating 200+ Montevideo units. - Rule out other contributing factors such as fetal malposition (occiput posterior), cephalopelvic disproportion (CPD), or maternal exhaustion. - Continuously monitor fetal heart rate (FHR) for signs of intolerance to labor, such as late decelerations or minimal variability, which may necessitate expedited delivery. Clinical Management Considerations Once active phase arrest is diagnosed, interventions may include amniotomy (if membranes are intact), oxytocin augmentation to optimize contraction pattern, intrauterine resuscitation (maternal repositioning, IV fluid bolus), and evaluation for operative vaginal or cesarean delivery if progress remains inadequate. The nurse's role is to advocate for timely intervention and provide clear communication to the patient and healthcare team. ## 핵심 개념 - **Labor Dystocia** — Abnormally slow or difficult labor, often diagnosed by a lack of progress in cervical dilation or fetal descent despite adequate contractions. - **Active Phase Arrest** — A type of labor dystocia defined as no cervical change for 4 hours or more with adequate contractions, or 6 hours or more with inadequate contractions. - **Adequate Uterine Contractions** — Contractions occurring every 2-3 minutes, lasting 60-90 seconds, and generating sufficient intrauterine pressure (approximately 200 Montevideo units) to cause cervical change. - **Multigravida** — A woman who has been pregnant and given birth two or more times. ## 같은 주제 문제 - [A primigravida at 40 weeks gestation has been in active labor for 14 hours. 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