# A nurse is assessing a multigravida client at 38 weeks gestation who has been in active labor for 8 hours. The cervix remains at 6 cm dilation with minimal change over the past 4 hours. Fetal heart rate is 140-150 bpm with good variability. Which assessment finding would be most indicative of cephalopelvic disproportion (CPD)?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=543054  
> language: ko  
> subject: Maternal Newborn Health

## 문제

A nurse is assessing a multigravida client at 38 weeks gestation who has been in active labor for 8 hours. The cervix remains at 6 cm dilation with minimal change over the past 4 hours. Fetal heart rate is 140-150 bpm with good variability. Which assessment finding would be most indicative of cephalopelvic disproportion (CPD)?

## 보기

1. Maternal exhaustion and request for pain medication
2. Irregular uterine contractions occurring every 2-3 minutes
3. Fetal station remaining at -2 despite adequate contractions **✔ 정답**
4. Cervical edema and anterior lip present during contractions

**정답: 3**

## 해설

Fetal station remaining at -2 despite adequate contractions is most indicative of CPD, as it shows mechanical obstruction preventing descent. Other findings (maternal exhaustion, irregular contractions, cervical edema) are less specific to CPD.

## 심화 해설

Clinical Judgment
This question evaluates Clinical Judgment in differentiating the causes of Dystocia. The core is to find "the reason why progression has stopped despite adequate contractions." The given situation (primipara, 12 hours of labor, arrested at 6 cm for 4 hours) suggests Protracted Labor or Arrest of Labor. The most important assessment here is Fetal Descent. Option 3's "fetal station remains at -2 despite adequate contractions" is the most specific finding that directly indicates a mechanical obstacle, namely Cephalopelvic Disproportion (CPD), where the fetal head cannot pass through the pelvis. Other options can be associated with CPD but more commonly appear with other causes (maternal fatigue, uterine dysfunction, cervical issues).

Memory Tip
Key to remembering CPD: "**H**ead **W**on't **D**rop." If the fetal **S**tation shows **N**o change despite **A**dequate contractions, suspect CPD.

KR vs US
In Korea, when a primipara has protracted labor, CPD may be suspected but a relatively longer observation period might be attempted. However, under US NGN/NCLEX standards, when clear Arrest of Labor criteria are met (no progress for ≥4 hours after ≥4 cm dilation with adequate contractions), especially if accompanied by arrest of fetal descent, the likelihood of CPD is assessed as high, prompting notification of the HCP to facilitate a review for cesarean section.

## 임상 시나리오

Clinical Practice Guide
When dystocia is suspected, systematically evaluate the 3Ps: Powers (contractions), Passenger (fetus), Passage (birth canal). CPD is primarily a mismatch between the Passenger (fetal size/position) and the Passage (pelvic size/shape). Fetal station is assessed by vaginal examination and measured in centimeters relative to the ischial spines (0 station), ranging from -5 to +5.
Caution
In SATA (Select All That Apply) questions, if asked to choose "signs" of CPD, options 1 (maternal fatigue), 3 (arrest of fetal descent), and 4 (cervical edema) may all be included. However, in a question like this one that asks for the "most indicative" finding, arrest of fetal descent is the correct answer. The conditional phrase "despite adequate contractions" is the decisive clue.

## 핵심 개념

- **Cephalopelvic Disproportion** — Cephalopelvic disproportion. A condition where vaginal delivery is difficult due to a mismatch between the size of the fetal head and the maternal pelvis.
- **Fetal Station** — Fetal station. A measurement indicating the relative height between the fetal presenting part (usually the head) and the ischial spines within the maternal pelvis. It is marked from -5 (above) to +5 (below), with the ischial spines as 0.
- **Dystocia** — Difficult labor. A challenging delivery where labor does not progress within the normal timeframe. It occurs due to problems with Powers, Passenger, or Passage.
- **Arrest of Labor** — Arrest of labor. A condition in which cervical dilation or fetal descent does not progress for a certain period of time (usually 4 hours) despite adequate uterine contractions.
- **Protracted Labor** — Delayed labor. A condition where each stage of labor (dilation, descent) progresses at a slower rate than normal.

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