A woman in labor has been pushing for 4 hours.

Comprehensive and Detailed Explanation From Exact Extract (NCC-Referenced Sources)

According to the NCC C-EFM Exam Outline and AWHONN Fetal Heart Monitoring (5th & 6th ed.), recurrent variable decelerations with progressive reduction in variability reflect worsening fetal hypoxia, especially when coupled with prolonged second stage and arrest of descent.

AWHONN and Menihan both state that:

“Minimal variability with recurrent decelerations indicates inability of the fetus to maintain adequate oxygenation.”

“Failure of descent in second stage with non-reassuring patterns requires operative delivery.”

Creasy & Resnik emphasize that operative vaginal birth requires:

(1) fetal head at +2 station or below,

(2) favorable position,

(3) reassuring fetal status.

Here, the fetus is OP, descent has arrested, and FHR is non-reassuring. This contraindicates vacuum extraction.

Therefore, the appropriate management under NCC competencies is cesarean birth.