The ability of the fetus to successfully negotiate the pelvis during labor and delivery depends on the complex interactions of four variables: uterine activity, the fetus, the maternal pelvis and maternal well-being. This is also known as the four Ps: power, passage, passenger and psyche. Symptoms such as severe abdominal pain, dehydration, a distended bladder, frequent amniotic infection, or the baby not exiting the pelvis despite normal contractions Tx Low-dose administration of intravenous propranolol in abnormal labor augmented with oxytocin reduced the need for cesarean delivery, particularly among patients with inadequate uterine contractility.