Conclusion
The management of malpresentation, malposition, and CPD require obstetric skill that spans the antenatal, intrapartum, and postnatal periods. Imaging by ultrasonography provides useful information but should only be used in conjunction with careful clinical assessment.
The dynamic process of labour, particularly in the context of secondary arrest and arrest in the second stage of labour, requires sound diagnostic skills and expertise in both OVD and complex caesarean section. Contingency planning is essential and in many cases this will be an indication for reassessment in an operating theatre. Recourse to OVD, sequential use of instruments, or caesarean section should be individualized to the specific clinical circumstances, the skill of the obstetrician, and wherever possible the preferences of the mother.
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