CEPHALOPELVIC
assess the readiness of the cervix for
DISPROPORTION
SHORT HISTORY
The concept of cephalopelvic disproportion
has been recognized for centuries. In the
past, CPS was a leading cause of maternal
and fetal mortality during childbirth, before
the advent of modern obstetric practices,
women with CPD often had no choice but to
attempt a vaginal delivery, which frequently
resulted in obstructed labor and maternal or
fetal death.
In the early 1900s, advances in obstetric
anesthesia and surgical techniques led to the
development of cesarean delivery as a safe
and effective alternative to vaginal delivery in
cases of CPD.
DEFINITION OF TERMS
Obstetric Conjugate: Smallest diameter of
the pelvic inlet, measured from the
promontory of the sacrum to the posterior
aspect of the pubic symphysis.
Diagonal Conjugate: Distance between the
lower margin of the pubic symphysis and the
sacral promontory.
Pelvimetry: A measurement of the
dimensions of the pelvic
Station: A measure of the baby’s descent
through the birth canal, with zero station
indicating the level if the ischial spines of the
mother’s pelvis.
Bishop score: A scoring system used to
induction of labor, taking into account
factors such as cervical dilation,
effacement, and position.
Trial of Labor: AN attempt of vaginal
delivery after a previous cesarean delivery
or in cases of suspected CPD, in which the
progress of labor is closely monitored to
determine if a safe vaginal delivery is
possible
WHAT IS CEPHALOPELVIC
DISPROPORTION?
Cephalopelvic disproportion (CPD) is a
condition that occurs when the fetal head
is too large or the mother’s pelvis is too
small or narrow to allow for a safe vaginal
delivery. This can result in prolonged labor,
failure to progress, and increased risk of
complications for both the mother and
baby.
TYPES OF CPD
1. Relative CPS: This type of CPD occurs
when the fetal head is of normal size but
the mother’s pelvis is too small or
misshapen to allow for a safe vaginal
delivery. It can be caused by variety of
factors, such as pelvic injuries or
abnormalities, a small pelvis, or a
misshapen pelvis due to scoliosis or other
spinal deformities.
2. Absolute CPD: This type of CPD
occurs when the fetal head is too large to
fit through the mother’s pelvis, even if the
 pelvis is of normal size and shape.
Absolute CPD can be caused by genetic
factors that affect the size of the baby’s
head or conditions that cause the baby’s The pelvis is a bony structure that connects
head to become swollen or enlarged.
CAUSES:
Cephalopelvic disproportion (CPD) can be pelvis and the false pelvis
caused by a variety of factors, including:
1. Fetal Factors:
 Large Fetal Head
 Abnormal Fetal Position (breech or
transverse position),
 Shoulder Dystocia
2. Maternal Factors:
 Pelvic Injuries
 Pelvic Abnormalities
 Spinal Deformities
 Obesity
 Gestational Diabetes
 Advanced Maternal Age
3. Genetic Factors:
 Fetal Macrosomia
 Pelvic Dystocia
 Hydrocephalus
 Osteogenesis Imperfecta
 Ehlers-Danlos Syndrome
RISK FACTORS
 Fetal Size
 Maternal Size
 Pelvic Abnormalities
 Previous History of CPD
 Prolonged Labor
 Fetal Malpresentation
 Maternal Age
ANATOMY AND PHISIOLOGY
the spine to the legs. It is composed of
several bones, including the sacrum,
coccyx, illium, ischium, and pubis. The
pelvis is divided into two parts, the true
The true pelvis is the lower part of the pelvis
that surrounds the birth canal. It is
composed of the sacrum, coccyx, and the
two pelvic bones (illium, ischium, and
pubis). In which the baby’s head passes
through this part.
The false pelvis, also known as the greater
pelvis, is the upper part of the pelvis that is
located above the pelvic brim. It is
composed of the iliac bones, which are the
largest bones in the pelvis, and forms the
flaring portion of the hips. The false pelvis
support the weight of the upper body and
provides attachment for various muscles
and ligaments, including the abdominal
muscles and the muscles of the back.
TYPES OF PELVIS
1. Gynecoid Pelvis: This is the most common
type of pelvis in women and is
characterized by a round or oval shape. It
is well-suited for childbirth, as it has a wide
pelvic inlet, a broad pubic arch, and a deep
pelvic cavity.
2. Android Pelvis: A more common in men
and us characterized by a triangular
shape. This is not well-suited for childbirth,
 as it has a narrow pelvic inlet, a narrow
pubic arch, and a shallow pelvic cavity.
3. Anthropoid Pelvis: Characterized by an
oval shape that is longer from front to
back. It is well-suited for childbirth, as it
has a wide pelvic inlet and a deep pelvic
cavity. However, the narrow transverse
diameter can make it difficult for the baby
to pass through
4. Platypelloid Pelvis: Characterized by a flat
and wide shape. It is rare and not well-
suited for childbirth, as it has a narrow
pelvic inlet and a shallow pelvic cavity
PATHOPHYSIOLOGY
DISPROPORTION BETWEEN HEAD OF THE
BABY AND THE MOTHER’S PELVIS
FETUS DOES NOT ENGAGE BUT
REMAINING FLOAT
VI. Failure of induction: If the induction fails
TRIAL OF PELVIC
MALPOSITION
LABOR PROBLEMS
PROLONGED
LABOR
DELAYED
SECOND STAGE
FETAL
DISTRESS
SIGNS AND SYMPTOMS
I. Failure to Progress during Labor: The
most common signs of cephalopelvic
disproportion is a failure of labor to
progress despite regular contractions.
II. Prolonged Labor: Labor that lasts longer
than 20 hours in a first-time mother and
longer than 14 hours in subsequent
deliveries may be a sign of
cephalopelvic disproportion.
III. Fetal Distress: If the baby’s heart rate is
abnormal or there are signs of distress,
it may indicate that baby is not getting
enough oxygen because of
cephalopelvic disproportion
IV. Abnormal Position of the Baby: If the
baby is in breech (bottom first) or
transverse (sideways) position, it may
indicate that there is not enough space
in the pelvis to turn into correct position
for delivery
V. Large Baby Size: If the baby is larger
than average (macrosomia), it may
suggest CPD as the baby’s head may
be too big to pass through the pelvis.
to start labor or progress is slow, it may
indicate that cephalopelvic disproportion
is preventing the baby from descending
into the birth canal.
COMPLICATIONS
I. PROLONGED LABOR: Can cause a
prolonged labor or obstructed labor,
which can increase the risk of maternal
and fetal complications such as fetal
distress, maternal exhaustion, and
postpartum hemorrhage.
II. FETAL DISTRESS: When a baby is
unable to pass through the birth canal
due to CPD, it can lead to fetal distress,
which can cause lack of oxygen and
nutrients to the bay, leading to brain
damage or even death.
III. POSTPARTUM HEMORRHAGE: CPD IV. Contraction Stress Test: Measures the
can increase the risk of postpartum baby’s heart rate in response to
hemorrhage, which is excessive bleeding contractions to assess fetal well-being
after delivery and determine if the baby can withstand
IV. SHOULDER DYSTOCIA: CPD can cause the stress of labor.
the baby’s shoulder to get stuck during V. Elective Cesarean Delivery: In some
the delivery, which can lead to injury and cases, an elective cesarean delivery may
other complications be recommended if the healthcare
V. BIRTH INJURIES: Such as skull provider determines that vaginal delivery
fractures, nerve damage, and brachial is not safe.
plexus injuries.
VI. CESAREAN SECTION: In many cases of
THERAPEUTIC MANAGEMENT
CPD, a cesarean section may be
necessary to safely deliver the baby. I. Induction of Labor: If the mother’s cervix
is favorable, a healthcare provider may
recommend induction of labor using
DIAGNOSTIC TESTING medications to stimulate contractions
The diagnosis of cephalopelvic disproportion II. Augmentation of Labor: If a labor is
progressing slowly, a healthcare
(CPD) can be challenging and requires a
provider may recommend augmentation
combination of medical history, physical
of labor using medications to strengthen
examination, and diagnostic testing. Some of
contractions
this includes the ff:
III. Cesarean Delivery: In some cases
I. Pelvic Examination: A pelvic examination where vaginal delivery is not possible
is performed by a healthcare provider to due to CPD or fetal distress, a cesarean
assess the size and shape of the delivery may be recommended to
mother’s pelvis, the position of the baby, ensure the safety of the mother and
and the cervix’s dilation. baby
II. Fetal Ultrasound: This can measure the IV. Vacuum or Forceps Delivery: In some
size of the baby’s head and estimate the cases, a healthcare provider may
baby’s weight, which can help determine attempt to a vacuum or forceps delivery
if the baby is too large to pass through to assist the baby’s descent through the
the mother’s pelvis. birth canal.
III. Pelvimetry: This test involves taking V. Pelvic Exercises: Such as pelvic tilts,
measurements of the mother’s pelvis to may be recommended to improve the
determine if there is enough space for the pelvic alignment and potentially reduce
baby to pass through. It can be done the severity of CPD
through X-ray of MRI.
 Infections can quickly become life-
threatening, especially if the patient
undergoes an operative delivery.
NURSING DIAGNOSIS AND
INTERVENTIONS
INTERVENTIONS:
I. RISK FOR FETAL DISTRESS RELATED
 Monitor the patient’s vital signs
TO RPOLONGED LABOR AND
frequently
OBSTRUCTED LABOR: Fetal distress
 Administer antibiotics as ordered
can quickly become life-threatening.
 Educate the patient and their family
Nurses should closely monitor the fetal
on signs and symptoms of infection
heart rate and communicate any signs of
 Encourage the patient to practice
distress to the healthcare team.
good hygiene
INTERVENTIONS:
 Assess the fetal heart rate
 Monitor mother’s contractions and
cervical dilation
 Oxygen therapy
 Changing maternal positions

II. RISK FOR INJURY RELATED TO

INSTRUMENTAL DELIVERY:
Vacuum forceps delivery may be
necessary in cases of CPD, which can
increase the risk of injury to the mother
and baby.
INTERVNETIONS:
 Assessing baby’s head position
 Assessing mother’s pain level
 Monitor vital signs
 Administering pain medication
 Monitoring for signs of injury

III. RISK FOR INFECTION RELATED TO

PROLONGED LABOR