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If after 4 hours not progressed, then can to arm and oxytocin and wait another 2 hours. IF not imporved, then check wheher mother and fetus doing well. IF well can wait for another 2 hours while diagnosing why. If not then find out why. and if all okay then give one more hour. IF found out anything wrong at a any point must take action. if exhausted hours of waiting then diagnose obstructed labour and then take action. so 4 + 2 + 2 + 1
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Must be able to diagnose whats happening based on the partogram!
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Oxytocin augmentation not that necssarily if have good contractions. So can reassess menwhile check for other problems.
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Vaccum delivery must be only done when cervix is fully dialated. and no cpd.