Cephalopelvic Disproportion

CEPHALOPELVIC DISPROPORTION
(CPD)
• Cephalo-pelvic disproportion is the failure of the head of the fetus to
descend through the pelvis when there is efficient uterine contraction
and moulding of the head.
• Cephalo-pelvic disproportion is a misfit between the fetal head and
the maternal pelvis
• This is diagnosed when the fetal head does not engage in the pelvis
after 36 weeks of pregnancy in primipara.
CEPHALOPELVIC DISPROPORTION
(CPD)
• It can also be described as disparity between the size of the woman’s
pelvis and the fetal head which makes vaginal delivery impossible
• Cephalo-pelvic disproportion can take place in the brim, cavity and

the outlet.
CAUSES
• Cephalo-pelvic disproportion occurs because the presenting diameter of

the fetal head is larger than the diameter of the maternal pelvis through
which it has to pass.
1. Contracted pelvis
The diameters of the brim, cavity or outlet is shortened. It therefore
interferes with labour e.g. Ricketic flat pelvis
2. Naegele’s Pelvis
There is only one wing of the sacrum due to poor development or
diseases of the sacroiliac joint. The brim is obliquely contracted.
CAUSES
3. Robert’s Pelvis
There are no wings of the sacrum and there is fusion of both sacro-iliac
joints.
4. Android Pelvis
This results in deep transverse arrest due flat sacrum and sharp ischial
spines at the outlets.
5. Platypelloid Pelvis
During labor the head will engage in the transverse diameter of the brim,
rotation of the head may be restricted and deep transverse arrest of the
head may occur.
DEGREE OF CEPHALOPELVIC DISPROPORTION
A. Minor Degree
• In this, the anterior parietal bone is at the level of the anterior border
of the symphysis pubis.
B. Moderate Degree
• The head slightly overlaps the anterior edge of the symphysis pubis.
Head can not enter the brim.
C. Major Degree
• There is a pronounced overlapping of the head over the anterior edge
of the symphysis pubis
CPD
• NOTE: The head is the largest part of the fetus and if it passes through
the brim of the pelvis then the rest of the foetus should pass through
without difficulty.
SIGNS AND SYMPTOMS
• During the last two or three weeks of pregnancy it may be found that
the foetal head has not engaged in primipara
DIAGNOSIS OF CPD
History
• The midwife should suspect possible disproportion if there is a history of:
1. Medical conditions such as rickets or osteomalacia which could
adversely affect the size and shape of the pelvis.
2. Spinal deformities such as scoliosis
3. Pelvic fracture or injuries which may have altered the normal shape and
dimensions of the pelvis
4. Obstetric complications such as previous prolonged labor, difficult
delivery, caesarian section or perinatal death.
EXAMINATION
• On examination of the woman the possibility of cephalo-pelvic

disproportion should be considered if:
i. The woman is of short stature, less than 152cm or
ii. The fetus seems unduly large
Note:
• The possibility that disproportion is present is much greater in a
primigravida than in a multi-gravida with the history of previous
normal delivery, but it can occur since the size of the fetus may have
been smaller in previous pregnancies.
EXAMINATION
• It is difficult to assess the size of the foetus accurately by palpation,
but it possible for an experienced midwife to determine whether the
fetus is excessively large for the duration of pregnancy.
• If the head is not engaged by 38th week in a primigravida, the woman
should be referred to the obstetrician for assessment
EXAMINATION
• X-ray pelvimetry
• Ultrasound
• MRI
• Evaluation of the progress of labor. (This is considered as far more
accurate indicator of cephalo-pelvic proportion)
MANAGEMENT
Community/Clinic/Health care
• The midwife should:
1. Reassure client and explain condition to her
2. Check temperature, pulse, respiration and blood pressure
3. Check fetal heart rate
4. Take blood for grouping and cross-matching (analysis at the hospital)
5. Give IV fluid and insert folley’s catheter
6. Give antibiotics (amoxicillin or ampicillin)
7. Give analgesia
8. Refer
HOSPITAL MANAGEMENT
• The midwife should:

1. Reassure client and explain condition to her
2. Inform the doctor
3. Check temperature, pulse, respiration and blood pressure
4. Take blood for grouping and cross-matching
5. Give IV fluid
6. Insert folley’s catheter
7. Check foetal heart rate
HOSPITAL MANAGEMENT
• The doctor will assess the client to determine the degree of disproportion.
The mother is prepared physically and psychologically for:
1. Caesarian section – for definite disproportion
2. Trial of labor when there is slightly disproportion which may well be
overcome successfully in labor
• If there are no other complications the woman is admitted to hospital for
trial of labor
• The mother and the fetus are monitored carefully
• The facilities and personnel needed for any emergency intervention are
made available.
DANGERS/COMPLICATIONS
• If cephalo-pelvic disproportion is not detected it will lead to dangers in both the mother and fetus.
a) Mother
• Obstructed labor
• Ruptured uterus
• Maternal distress
• Postpartum haemorrhage
• Chronic ill health
• Infection
• Maternal death
b) Fetus
• Fetal distress
• Fetal death

Cephalopelvic Disproportion

Uploaded by

Copyright:

Available Formats

Cephalopelvic Disproportion

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Cephalopelvic Disproportion

Uploaded by

Copyright:

Available Formats

CEPHALOPELVIC DISPROPORTION

• Cephalo-pelvic disproportion can take place in the brim, cavity and

• Cephalo-pelvic disproportion occurs because the presenting diameter of

• On examination of the woman the possibility of cephalo-pelvic

• The midwife should:

You might also like