# A 32-year-old multigravida at 39 weeks gestation has been in active labor for 14 hours. Her cervix is 6 cm dilated and has remained unchanged for the past 4 hours despite adequate uterine contractions. The fetal heart rate is reassuring. What is the most appropriate nursing intervention at this time?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=543057  
> language: ko  
> subject: Maternal Newborn Health

## 문제

A 32-year-old multigravida at 39 weeks gestation has been in active labor for 14 hours. Her cervix is 6 cm dilated and has remained unchanged for the past 4 hours despite adequate uterine contractions. The fetal heart rate is reassuring. What is the most appropriate nursing intervention at this time?

## 보기

1. Encourage the client to ambulate in the hallway to promote cervical dilation
2. Notify the healthcare provider immediately about the lack of cervical progress **✔ 정답**
3. Increase the frequency of position changes to facilitate fetal descent
4. Administer pain medication to help the client relax and promote labor progress

**정답: 2**

## 해설

Secondary arrest of labor requires immediate medical evaluation. Other options may help but do not address the need for provider intervention.

## 심화 해설

Understanding the Clinical Scenario

The scenario describes a 32-year-old multigravida at term in active labor for 14 hours. A critical finding is that her cervix is 6 cm dilated and has shown no change for 4 hours despite adequate contractions. This pattern is the defining characteristic of labor arrest, specifically active phase arrest. According to modern obstetric guidelines, active phase arrest is diagnosed in a patient who is ≥6 cm dilated with ruptured membranes and has no cervical change after ≥4 hours of adequate uterine contractions, or ≥6 hours of inadequate contractions with oxytocin administration .

Analyzing the Options

The correct answer is to notify the healthcare provider. The diagnosis of labor arrest represents a point where the current labor process is no longer progressing toward a safe vaginal delivery. Continuing to manage the patient solely with nursing comfort measures without a provider’s reassessment delays necessary medical intervention. A quality-improvement study on labor arrest guidelines demonstrated that adherence to these specific diagnostic criteria is crucial for timely decision-making and can reduce the primary cesarean delivery rate without compromising maternal or neonatal safety .

- Option 1 (Ambulation) and Option 3 (Position changes): While these are excellent nursing interventions for promoting labor progress in a normally progressing labor, they are no longer the priority once the criteria for labor arrest are met. The underlying issue is no longer one that can be reliably resolved by gravity or pelvic mobility. The study on the peanut ball device, a noninvasive positioning tool, showed its effectiveness in reducing labor pain and stress in low-risk primigravid women, but its primary role is to facilitate progress, not to treat a diagnosed arrest disorder . The patient’s condition has moved beyond the scope of these interventions alone.

- Option 4 (Pain medication): Administering pain medication to promote relaxation may be a supportive measure, but it does not address the core problem of a stalled labor that has met the strict definition of arrest. The priority is a medical evaluation to determine the next step, which may include oxytocin augmentation, artificial rupture of membranes if not already done, or operative delivery. Masking the situation with analgesia without a clear plan from the provider is not appropriate.

Connecting the Evidence to Practice

The educational intervention study on labor arrest guidelines highlights a common gap between clinical practice and evidence-based definitions. It emphasizes that a clear understanding of the “4-hour rule” for active phase arrest is essential for all members of the obstetric team, including nurses . As the nurse at the bedside, recognizing that the patient’s stalled cervical dilation for 4 hours at 6 cm is a sentinel event that requires immediate provider notification is a critical patient safety action. While noninvasive comfort and positioning techniques, such as the use of a peanut ball, are valuable tools for managing labor pain and potentially aiding descent in a progressing labor, their efficacy is studied in the context of preventing complications, not resolving a confirmed arrest . The nurse’s most appropriate intervention is to communicate this specific, criteria-based finding to the provider to facilitate a timely medical decision.

## 임상 시나리오

Clinical Practice Guide: Managing Active Phase Arrest

**Scenario:** A 32-year-old multigravida at 39 weeks has been in active labor for 14 hours. Her cervix is 6 cm dilated and unchanged for 4 hours despite adequate contractions. The fetal heart rate is reassuring.

**Key Action:** Immediately notify the healthcare provider. This clinical picture meets the diagnostic criteria for active phase arrest, a labor dystocia that requires prompt medical reassessment and intervention beyond independent nursing measures.

Diagnostic Criteria for Active Phase Arrest

- Cervical dilation is 6 cm or greater with ruptured membranes.

- No cervical change for 4 hours or more despite adequate uterine contractions (e.g., every 2-3 minutes, lasting 40-60 seconds, 200+ Montevideo units).

- Alternatively, no cervical change for 6 hours or more of oxytocin administration with inadequate contractions.

Nursing Priorities and Rationale

- **Provider Notification:** The first and most critical step. Continued nursing comfort measures without medical evaluation delay necessary decisions, such as oxytocin augmentation, amniotomy, or cesarean delivery.

- **Defer Independent Interventions:** Ambulation, position changes, and pain management are supportive for normal labor progress but are insufficient to resolve a diagnosed arrest. Their use should not postpone communication with the provider.

- **Continuous Monitoring:** Maintain continuous electronic fetal monitoring and tocodynamometry while awaiting the provider's assessment to ensure ongoing fetal well-being and contraction adequacy.

- **Documentation:** Clearly document the time of arrest diagnosis, cervical exam findings, contraction pattern, fetal status, and the exact time of provider notification.

**Safety Tip:** Adherence to standardized labor arrest criteria supports timely clinical decisions and can reduce primary cesarean delivery rates without compromising maternal or neonatal outcomes.

## 핵심 개념

- **Active Phase Arrest** — A labor dystocia diagnosed when a woman at 6 cm or greater dilation with ruptured membranes has no cervical change after 4 or more hours of adequate contractions.
- **Adequate Uterine Contractions** — Contractions occurring every 2-3 minutes, lasting 40-60 seconds, and generating 200-250 Montevideo units on an intrauterine pressure catheter.
- **Multigravida** — A woman who has been pregnant more than once.
- **Reassuring Fetal Heart Rate** — A fetal heart tracing with a baseline of 110-160 bpm, moderate variability, accelerations, and no late or significant variable decelerations.

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