OB - article abt.

Cephalopelvic disproportion
Title: The Relation between Head Circumference and Mid-Pelvic Circumference: A Simple
Index for Cephalopelvic Disproportion Evaluation

INTRODUCTION OF THE ARTICLE AND THE DISEASE (CPD)

• This article explores a new way to predict a common problem in childbirth called
cephalopelvic disproportion (CPD). CPD happens when the baby's head is too big to
pass through the mother's pelvis during birth. The study looks at the relationship
between the size of the baby's head and the mother's pelvis by measuring the head
circumference (HC) and pelvic circumference (PC). Researchers found that a ratio
called the cephalopelvic circumference index (CPCI) could help predict CPD. They
studied 104 deliveries and found that the CPCI was higher in cases where a cesarean
delivery was needed due to CPD. This means that when the ratio between the head
and pelvis measurements was higher, there was a greater chance of CPD. The study
suggests that this ratio could be a simple way to identify mothers at higher risk of CPD,
but more research is needed to confirm its usefulness.
• So, to understand the article more let's define what CPD first. Cephalopelvic
disproportion (CPD) occurs when the baby’s head or body is too large to pass through
the mother’s pelvis during childbirth.

RISK/ CONTRIBUTING FACTORS - BAKIT NAGKAKAROON NG GANITONG SAKIT?

Cephalopelvic disproportion (CPD) presents various risks for both the mother and the baby.
Let's begin by exploring the potential risks associated with the mother.
MATERNAL FACTORS
1. Problema sa Pelvis
➢ Small Pelvis (maliit na pelvic) - A naturally small pelvis may not accommodate a larger
baby.
➢ Abnormal Pelvic Shape - Variations in pelvic shapes, such as a platypelloid or android
pelvis and pwede din dahil sa mga naging previous accident like vehicle accident, can
make vaginal delivery more difficult.
2. Height - Short stature, often defined as less than 5 feet (152 cm), is associated with a
higher risk of CPD.
3. Obesity - Excess weight can affect the shape and size of the pelvis and also contribute
to larger fetal size.
4. Age (edad) - Mostly affected dito is yung mga Very young mothers (teenagers) and
older mothers (above 35) may have an increased risk.
5. Previous CPD - A history of CPD in a previous pregnancy increases the likelihood of
recurrence.
FETAL FACTORS
 1. Large Baby – So kapag diabetes ang inang nagbubuntis, mas malaki and posibilidad na
magiging malaki ang sanggol sa sinapupunan nito. A baby weighing more than 4,000
grams (8 pounds, 13 ounces) is at higher risk for CPD.
2. Postmature na ang baby, kapag labis na sa 42 weeks and pagbubuntis
3. Malpresentation - Positions such as breech (bottom first) or transverse lie (sideways)
can lead to difficulties in delivery.
4. Hydrocephalus - an excessive accumulation of cerebrospinal fluid in the brain
(hydrocephalus) can enlarge the baby’s head, making it difficult to pass through the
birth canal.
MEDICAL CONDITIONS
1. Gestational Diabetes - Can lead to fetal macrosomia, increasing the risk of CPD.
2. Preexisting Diabetes - Similarly contributes to larger fetal size.

NURSING PRIORITY
• Continuous Monitoring: Regular assessment of maternal vital signs, fetal heart rate,
and uterine contractions is essential to detect any signs of distress or complications
promptly. Continuous electronic fetal monitoring helps in assessing the baby's well-
being and detecting any abnormalities in the labor process.
• Pain Management: Providing effective pain relief measures, such as pharmacological
(analgesics, epidural anesthesia) or non-pharmacological methods (positioning,
massage, relaxation techniques), to help the mother cope with labor pain and
discomfort.
• Positioning: Encouraging position changes that can facilitate labor progress and
optimize fetal positioning. Certain positions, such as hands-and-knees, side-lying, or
upright positions, may help alleviate pressure on the pelvis and promote better fetal
descent.
• Emotional Support: Offering emotional support, reassurance, and encouragement to
the mother and her support person(s) throughout the labor process. Providing clear
communication about the progress of labor and any interventions being considered
helps alleviate anxiety and promote a sense of control.
• Collaboration with Healthcare Team: Collaborating closely with obstetricians,
midwives, and other members of the healthcare team to implement the most
appropriate management strategies for labor and delivery. This includes advocating
for the mother's preferences while ensuring the safety of both mother and baby.
• Preparation for Cesarean Section: If vaginal delivery becomes unlikely or if
complications arise necessitating a cesarean section, preparing the mother both
physically and emotionally for the procedure. This includes explaining the process,
obtaining informed consent, and ensuring readiness for surgery.
• Education and Support for Breastfeeding: Providing information and support regarding
breastfeeding and newborn care, including skin-to-skin contact immediately after birth,
to promote bonding and successful breastfeeding initiation.
• Postpartum Care: Monitoring the mother and baby closely in the postpartum period for
any signs of complications or difficulties. Providing assistance with breastfeeding, pain
management, and recovery support as needed.
 SPECIAL TREATMENTS / LAB TEST
• Cesarean Delivery (C-Section) - If CPD is diagnosed or strongly suspected, a cesarean
delivery may be planned or performed urgently to ensure the safety of the mother and
baby. The surgery involves delivering the baby through an incision made in the mother's
abdomen and uterus.

DIAGNOSTIC PROCEDURES

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DRUG MEDICINES
• Pain Relief Medications: Analgesics or epidural anesthesia may be administered to
alleviate pain during labor. These medications can help the mother manage the
discomfort associated with prolonged labor, which can occur with CPD.
• Oxytocin (Pitocin) may be given to induce or augment labor if it's progressing slowly
due to CPD. Oxytocin can strengthen uterine contractions, helping the cervix to dilate
and the baby to descend through the birth canal.
• Muscle Relaxants: In cases of severe CPD leading to prolonged labor or fetal distress,
muscle relaxants may be used to ease tension in the pelvic muscles and facilitate
delivery.
• Antibiotics: If there's an increased risk of infection due to prolonged labor or
interventions like a prolonged rupture of membranes (PROM), antibiotics may be
administered to prevent or treat infections.
• Anesthesia for Cesarean Section: In cases where vaginal delivery is not possible due to
CPD, a cesarean section may be performed. Anesthesia, such as epidural or spinal
anesthesia, is typically administered to numb the lower half of the body before the
surgery.
• Antiemetics: If the mother experiences nausea or vomiting during labor, antiemetic
medications may be given to alleviate these symptoms.

HEALTH TEACHINGS
• Understanding CPD: Explain what CPD is and how it affects labor and delivery. Describe
the reasons why CPD may occur, including maternal pelvic size and fetal size.
• Risks and Complications: Discuss potential risks and complications associated with CPD
for both the mother and the baby. Emphasize the importance of close monitoring and
timely interventions to ensure a safe delivery.
• Labor Expectations: Help the patient understand that labor may be prolonged and more
challenging due to CPD. Discuss strategies for coping with labor pain and maintaining
patience during the process.
• Labor Positions: Encourage the patient to try different labor positions that may help
optimize the baby's descent through the birth canal. Provide guidance on positions such
as upright, side-lying, and hands-and-knees positions.
• Emphasize the importance of having a supportive birth partner or doula present during
labor to provide emotional support and assistance.
• Cesarean Section: Provide information about cesarean delivery, including the
indications, procedure, recovery process, and potential risks and benefits. Address any
concerns or questions the patient may have about cesarean birth.
• Postpartum Recovery: Discuss expectations for postpartum recovery after either
vaginal delivery or cesarean section. Provide guidance on wound care, pain
management, breastfeeding support, and emotional well-being.
• Encourage the patient to maintain a healthy lifestyle during pregnancy and beyond,
including regular prenatal care, nutritious diet, regular exercise, adequate rest, and
stress management.
• Provide emotional support and reassurance to the patient and their support system.
Acknowledge their feelings and concerns about CPD and childbirth, and offer resources
for additional support if needed, such as counseling services or support groups.

DOES THE DISEASE CAUSE OTHER COMPLICATIONS? WHAT ARE THEY?

• Prolonged labor, also known as labor dystocia, is a common complication of CPD
(Labor that lasts more than 20 hours for first-time mothers or more than 14 hours for
women who have previously given birth). When the baby cannot progress through the
birth canal due to a size mismatch, labor can extend beyond the normal duration. This
can lead to maternal exhaustion, increased pain, and heightened stress. Prolonged
labor also raises the risk of infections for both the mother and the baby, as the
prolonged rupture of membranes provides an entry point for bacteria. In some cases,
prolonged labor can cause uterine atony, where the uterus fails to contract effectively
after delivery, leading to excessive bleeding and postpartum hemorrhage.

• Hypoxia – Fetal distress- During labor, if the baby cannot move through the birth canal
properly, it can become stressed. This is known as fetal distress. Fetal distress is
typically indicated by an abnormal heart rate, which can be detected through
continuous fetal monitoring. If the baby is in distress for too long, it might not get
enough oxygen, which can cause serious health issues or even long-term developmental
problems.

• Birth Injuries - CPD can increase the risk of physical injuries to the baby during delivery.
For instance, if forceps or a vacuum extractor are used to help deliver the baby, there
is a risk of bruising or injury to the baby’s head or shoulders. In severe cases, the baby
might suffer from nerve damage or fractures. These injuries can require medical
treatment and extended care after birth.

• Maternal Injuries - The mother can also suffer injuries due to CPD. If labor is prolonged
and difficult, there might be tears in the birth canal, which can cause significant pain
and require stitches to heal. Additionally, if a cesarean section is needed, the mother
will have to recover from surgery, which includes managing pain, preventing infection,
and allowing the surgical wound to heal. This recovery process can be longer and more
complicated than recovery from a vaginal birth.

• Postpartum Hemorrhage - CPD can increase the risk of heavy bleeding after delivery,
known as postpartum hemorrhage. This happens because the uterus can become
overworked and might not contract properly after the baby is born, leading to
excessive blood loss. Postpartum hemorrhage is a serious condition that can require
blood transfusions, medications to stop the bleeding, and sometimes additional surgery
to manage.
• Uterine rupture is a rare but serious complication where the uterus tears during labor.
This can happen if there is too much pressure on the uterus from a prolonged and
obstructed labor due to CPD. Uterine rupture is a medical emergency that can lead to
severe bleeding and can be life-threatening for both the mother and the baby.
Immediate surgery is needed to repair the uterus and deliver the baby safely.
 • Infections can occur due to prolonged labor and the interventions needed for CPD. The
longer labor lasts, the greater the risk of bacteria entering the birth canal and causing
infections in the mother, such as endometritis (infection of the uterine lining). If a
cesarean section is performed, there is also a risk of surgical site infections. Infections
can lead to fever, pain, and prolonged hospital stays and may require antibiotic
treatment.

PATHOPHYSIOLOGY
Explanation:
➢ Risk Factors: The process begins with the identification of risk factors for CPD. These
can be broadly categorized into fetal and maternal factors.
• Fetal factors: Mainly include macrosomia, which is a condition where the baby is larger
than expected for its gestational age.
• Maternal factors: These factors can be a history of previous CPD, a bony pelvis
deformity, or a condition where the mother's pelvis is smaller than average.

➢ Cephalopelvic Disproportion (CPD): If risk factors are present, it can lead to CPD, a
situation where the fetal head is too large or the mother's pelvis is too small to allow
for a safe vaginal delivery.

➢ Trial of Labor: In some cases, a trial of labor may be attempted, which is an attempt
at vaginal delivery despite the presence of CPD.

➢ Outcomes: The trial of labor can have two main outcomes:

• Vaginal Delivery: If successful, the baby can be delivered vaginally.
• Complications: If the trial of labor is not successful or becomes complicated, it can
lead to various complications for both mother and baby.

➢ Complications: Potential complications of CPD during labor include:

• Fetal distress: This is a condition where the baby isn't receiving enough oxygen.
• Uterine rupture: This is a tear in the uterus, which is a serious medical emergency.
• Prolonged labor: Labor that lasts longer than 24 hours can be exhausting for the mother
and increase the risk of infection.

➢ Cesarean Section: If CPD is diagnosed or complications arise during the trial of labor,
a cesarean section (C-section) will likely be recommended to deliver the baby safely.