A series of 234 nulliparas and 71 multiparas with protracted descent patterns was studied. Cephalopelvic disproportion, minor malpositions, excessive sedation and conduction anesthesia were considered to be possible etiologic factors. Concurrent dysfunctional dilatation patterns were seen in 70.8%, most commonly, in protracted active-phase dilatation and secondary arrest of dilatation. Conservatism in the form of expectancy and Support resulted in generally better perinatal outcome than did uterotonic stimulation. Infants, delivered by midforceps operations consistently fared poorest. The worst results are obtained from midforceps utilized in the presence of cephalopelvic disproportion. Details of analysis with regard to etiology, treatment and prognosis are presented, together with a program of management for the patient with a protracted descent pattern.