Table 1.

Labor dystocia and unplanned cesarean delivery

Unplanned cesarean indication	Clinical presentation	Potential pathophysiology
Failure to achieve active labor[22]	Does not meet active labor criteria1 despite oxytocin induction	Cervix inadequately prepared for labor Uterus inadequately prepared for labor Prematurity resulting in poor cervix/uterine preparation for labor
Arrest of dilation	Stalled cervical dilation during active labor1 [1, 22]	Inadequate uterine contractile force Uterus molecularly unprepared for labor Cervix molecularly unprepared for labor Obesity Infection Acute maternal stress response[92, 93, 135] Uterine metabolic fatigue
Arrest of descent	Failure of fetal presenting part to descend past 0 to + 1 station	Inadequate uterine contractile force Fetal malposition (e.g., occiput posterior) Cephalopelvic disproportion (e.g., large fetus, small pelvis)2 Reduced maternal expulsive effort

¹Active labor is defined as ≥ 6-cm cervical dilation or 4–5 cm with ≥ 1-cm cervical change over ≤ 2 h[1]

²Cephalopelvic disproportion can also cause arrest of dilation