Cephalopelvic disproportion, abnormal presentation; excessive uterine distention, parity >4, elderly multiparae, previous caesarean section or other uterine surgery; severe toxemia, predisposition to amniotic fluid embolism, hypertonic contractions, placenta praevia. Pregnancy, 1st stage labor, primary or secondary uterine inertia, 2nd stage of labor before crowning of the head. Severe cardiac, liver or kidney function disorders; occlusive vascular disease; sepsis. Severe HTN, preeclampsia & eclampsia.