A G3P1 at 39 5/7 weeks with spontaneous rupture of membranes, cervix 4 cm dilated and 80% effaced, vertex presentation at 0 station, with mild contractions. If there is no cervical change after 1–2 hours, what is the most appropriate management?

• A. Induction
• B. Augmentation
• C. Expectant management
• D. Cesarean

Answer: (B)

When contractions are inadequate after rupture of membranes, the best approach is to augment labor with IV oxytocin to strengthen and coordinate contractions. In this scenario, the patient is term and in active labor but has only mild contractions with a cervix stuck at 4 cm and no change for 1–2 hours. Augmentation helps convert a slow or arresting labor into a more productive one, speeding up dilation and descent toward vaginal delivery while the membranes are already ruptured.

Induction would not be appropriate here because labor has already started; the issue is not starting contractions but improving their effectiveness. Expectant management would mean waiting to see if labor progresses on its own, which risks prolonged ROM and infection without improving outcomes. Cesarean would be reserved for labor that fails to progress despite augmentation or for nonreassuring fetal status, neither of which is indicated in this case.