A clinician lists indications for emergency caesarean section in prolonged first stage. Which single scenario is a clear indication for caesarean rather than augmentation?

Answer: A. Cephalopelvic disproportion

Indications for caesarean in prolonged first stage

Caesarean section is indicated when vaginal delivery is unsafe or progress fails despite appropriate measures.

Indications

• Cephalopelvic disproportion.
• Malpresentation unsuitable for vaginal delivery.
• Poor progress despite augmentation.
• Evidence of fetal compromise.

This case

• CPD is a mechanical obstruction that augmentation cannot overcome, so caesarean is indicated.

Contrast

• Inadequate contractions with an adequate pelvis call for augmentation, not caesarean.