INTRODUCTION

Cephalopelvic disproportion (CPD)

is a pregnancy complication in which there is a size mismatch between the mother’s
pelvis and the fetus’ head. The baby’s head is proportionally too large or the mother’s pelvis
is too small to easily allow the baby to fit through the pelvic opening. This can make vaginal
delivery dangerous or impossible. If an attempted vaginal delivery is unsuccessful, doctors
should quickly move onto a C-section. If they fail to do this, prolonged/obstructed labor from
CPD may result in birth injuries such as hypoxic-ischemic encephalopathy (HIE) and cerebral
palsy (CP).

Causes and Risk Factors of Cephalovelvic Disproportion:

 Mother with gestational diabetes
 Post-term pregnancy
 Mother has a small pelvic outlet
 Congenital dislocation of the hips
 Shape of the pelvis from previous accidents
 Tumors of the bone
 Congenital deformity of the sacrum or coccyx
 Occipital posterior position

Signs and symptoms of Cephalopelvic disproportion (CPD)

The presence of certain conditions during labor and delivery indicate that there may be a case
of Cephalopelvic disproportion. If the Fetus maintains a high station, even after a significant
amount of contractions, this indicates that fetal descent through the birth canal may be
difficult. Although it is not the only potential explanation, CPD should be evaluated as a
possible cause of failure to descend.
Prolonged and arrested labor can result in oxygen deprivation, so medical professionals
should also watch for signs of fetal distress.

Diagnosing Cephalopelvic disproportion (CPD)

Listed below are several methods employed by physicians to try and assess the size of the
pelvis and baby, which can help to diagnose CPD:
Pelvimetry by MRI: This is used to assess the dimensions of the pelvis, determine the
baby’s position, and examine the soft tissues of the mother and baby.
Clinical Pelvimetry: This is a process used to assess the size of the birth canal using the
hands and/or with a pelvimeter.
Ultrasound: The baby’s head and body size are measured during a routine ultrasound
examination. Measurements are compared against standardized growth charts to determine
the relative risk of CPD by the time of delivery.
X-ray or CT Pelvimetry: This is a radiographic examination used to determine the
dimensions of the mother’s pelvis and the diameter of the baby’s head. The value of x-ray
Pelvimetry needs to be weighed against the risk of radiation exposure.
True CPD cannot always be clearly diagnosed before the beginning of labor. If medical
professionals believe they may be dealing with a case of CPD but aren’t entirely sure, they
may still attempt a vaginal delivery. However, they should be prepared to quickly move on to
an emergency C-section or other interventions (see “Treatment for Cephalopelvic
disproportion”) if labor stops or the infant fails to follow the expected rate of descent. If true
CPD is diagnosed prior to labor, a C-section may be scheduled in advance.

Treatment for Cephalopelvic disproportion (CPD)

Treatment for CPD varies based on severity and when it is diagnosed. If it is severe and
diagnosed early, a planned C-section is indicated. In other cases, CPD may be treated with a
symphysiotomy (the surgical division of pubic cartilage) or an emergency C-section after a
trial of labor. When CPD is present, continued attempts to deliver the baby vaginally can
cause undue trauma and permanent injury to the baby.

Cephalopelvic disproportion (CPD) and birth injuries

Physicians faced with CPD must be very skilled in treating this potentially dangerous
condition. Listed below are issues and complications that can occur when CPD is present.

Overdose of Pitocin (synthetic oxytocin): One of the major problems with CPD is that
physicians may react by administering Pitocin in an effort to speed up delivery. Too much of
this drug may cause excessive and traumatic contractions, which can harm the baby.
Prolonged Labor: Many physicians allow labor to progress for far too long. Labor is a
trying time for the baby, and if it is prolonged, oxygen-deprivation injuries may occur. These
injuries can lead to hypoxic-ischemic encephalopathy, cerebral palsy, and developmental
delays. Furthermore, the trauma from continued labor may result in serious intracranial
hemorrhages (brain bleeds).
Shoulder Dystocia: When CPD is present, the baby is more likely to have shoulder dystocia
injuries, including Erb’s Palsy or Klumpke’s palsy.
Umbilical Cord Compression: When there is decreased room in the uterus, either because
of a large baby or a small maternal pelvis, oxygen deprivation may occur due to a trapped
umbilical cord.
When risk factors for CPD are present, it is essential that the physician monitor the mother
and baby very closely and be prepared for a C-section delivery. In certain situations, an early
delivery may even be necessary. It is negligence when a mother and baby are not properly
assessed and monitored. Failure to act skilfully and, if necessary, quickly, also constitutes
negligence. If this negligence leads to injury of the mother or baby, it is medical malpractice.

CONCLUSION :

• Cephalopelvic disproportion (CPD) is ‘failure of the Fetus to pass safely through

the birth canal for mechanical reasons’
• There are numerous causes for CPD, but the most frequent is contracted pelvis
with an average sized infant
• CPD is best diagnosed by a trial of labour in a primigravida with oxytocin
augmentation, if needed, to ensure adequate uterine contractions
• CPD can be assumed when there is a need for caesarean section or symphysio-
tomy for poor labour progress, in the presence of adequate uterine contractions
• Untreated CPD results in obstructed labour, which is responsible for 8% of
maternal deaths worldwide.