Could you please explain why in these 2 questions the answer is Category 3 CS, rather than category 2?
1. A healthy 32 year old woman presents in spontaneous labour at 39 weeks gestation in her first pregnancy. Vaginal examination identifies the cervix to be 8 cm dilated with a frank breech presentation. Following assessment and counselling, a vaginal birth is planned. 4 hours later, the cervix is fully dilated with the breech at the ischial spines and there is effective epidural analgesia. After 1 hour of passive second stage, the breech remains at the level of the ischial spines. All maternal and fetal observations are normal.
2. You have reviewed a low-risk 26 year old primigravida who is in spontaneous labour at term because of confirmed delay in the second stage of labour. She has effective epidural analgesia and has been actively pushing for 2 hours. Maternal and fetal observations are normal. The vertex is 2/5th palpable on abdominal examination and there are 4 contractions every 10 minutes. The cervix is fully dilated with a direct occipito-posterior position 1 cm above the ischial spines. The membranes have ruptured and the liquor is clear.
