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CEPHALOPELVIC DISPROPORTION (CPD)
Definition:
Exists when the capacity of the pelvis is
inadequate to allow the fetus to negotiate the birth
canal. This may be due to a small pelvis, a
nongynecoid pelvic formation, and a large fetus.
Etiology:
The birth passage includes the maternal bony
pelvis, beginning at the pelvic inlet and ending at
the pelvic outlet. A narrowed diameter in these
areas can result in CPD if the fetus is larger than
the pelvic diameters.
Types of Female Pelvis:
1. The gynecoid pelvis- round shape
2. The android pelvis-heart shape
3. The anthropoid pelvis-long oval
4. The platypelloid pelvis-kidney shape
Degrees of CPD:
• Mild - Where the anterior parietal bone is at
level with symphysis pubis.
• Moderate - The head slightly overlaps at the
edge of the pubis
• Severe - The head bulges over the symphysis
pubis
Methods of determining CPD:
• Determining the degree of overlap by placing
the fingers on the symphysis pubis while
pressing the head down and with the other hand.
• Head fitting - Sitting patient up method - patient
lies on the bed. Let the patient to sit up by her
own effort. The effort should force the head into
the pelvis and the midwife will feel its slip past
her hand.
• Head fitting - left hand grip method - Grasp
head with left hand and push it downward and
backward if a sense of given’s felt there is no
overlap or CPD.
Causes of Cephalo Pelvic Disproportion:
Increased Fetal Weight:
Very large baby due to hereditary reasons - a
baby whose weight is estimated to be above 5
kgs or 10 pounds.
Post mature baby - when the pregnancy goes
above 42 weeks.
Babies of women with diabetes usually tend to
be big.
Fetal Position:
Brow presentation
Face presentation.
Problems with the Pelvis:
Small pelvis.
Abnormal shape of the pelvis due to diseases
like rickets, osteomalacia or tuberculosis.
Abnormal shape due to previous accidents.
Tumors of the bones.
Signs & Symptoms:
Prolonged labor
Cervical dilation and effacement are slow
Engagement of the presenting part is delayed
Adequacy of the maternal pelvis small for size
of fetus
Diagnostic Tests:
Clinical Pelvimetry: The assessment of the size of
the pelvis is made manually by examining the
pelvis and palpating the pelvic bonesby vaginal
examination. It is usually carried out after 37
weeks of pregnancy or at the time of the onset of
labor.
Radiological Pelvimetry: X-rays or CT scans are
taken of the pelvis in different angles and views
and the pelvic diameter measured. But this method
is not done nowadays as it can cause radiation
toxicity to the baby.
Ultrasound of fetus to determine the diameter of
fetal skull and to determine presentation,
presenting part, position, flexion and degree
descent of fetus.
Medical Management:
The adequacy of the maternal pelvis for a
vaginal birth should be assessed both during and
before labor. During the intrapartal assessment,
the size of the fetus and its presentation, position,
and lie must also be considered. Frequent
assessments of cervical dilation and fetal descent
are made. If progress ceases, the decision for a
cesarean birth is made.
Surgical Treatment:
If the surgeon is absolutely certain that there is
Cephalo Pelvic Disproportion, then a Cesarean
section is the only option to deliver the baby.
Nursing Management:
Vital signs Q4 hrs or as ordered by doctor.
Monitor both contractions and fetus
continuously.
Sitting or squatting increases the outlet
diameters and may aid in fetal descent.
Monitor fetus for signs of hypoxia take
appropriate actions if necessary.
Monitor mother and fetus for any signs of
distress.
Encourage pt to drink clear fluids to maintain
hydration.
Trial of Labour
Definition: - A test given to a woman with mild or
moderate CPD to see if she can deliver her baby
with least damage to herself & baby.
The outcome of a trial of labor depends on:-
1. The strength of uterine contraction
2. The stretch of the pelvic joints & ligaments
3. The degree of moulding
Management of a trial of labor
The trial of labour must be carried out in the
health where there is a service for caesarean
section at any time.
The Pregnancy is allowed to go to term
Careful observations are kept. Descent of the
head assessed frequently.
Strict asepsis is maintained as there is
possibility of caesarean section FHR and
mother’s pulse and B/P are also observed
“Descent is the most important observation”
Keep her comfortable
Stay with the patient, talk to her about the labor
progress, and help her to be relaxed
The following conditions should be reported:
Head still high after 6-8 hrs of good contraction
Rupture of membrane before full dilation.
Un satisfactory uterine action
Change of vertex to face or brow
Fetal distress
Maternal distress
A trial of labor has failed when one of the
following occurs
Fetal distress
Maternal distress
Failure to advance after 6-8hrs of good
contraction
When any of the three complications occurs
caesarean section will be done
