This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Gynaecology & Obstetrics
Delayed labour occurs in : 
Select and explain. 
A. Early use of epidural anesthesia with analgesia, B. Early use of analgesia, C. Unripened cervix, D. All of the above
D: All of the above
Answer: D: All of the above 
Explanation: Ans. is a, b and c i.e. Early use of epidural anesthesia with analgesia; Early use of analgesia; Unripened cervix; and Use of sedative early in course of labour Delayed / prolonged labour: "Labour is said to be prolonged when the combined duration of the first and second stage is more than the arbitrary time limit of 18 hours or when the cervical dilatation rate is less than 1 cm/hr and descent of the presenting pa is c 1 cm/hr for a period of 4 hours (WHO-1994)."