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CEPHALOPELVIC DISPROPORTION (CPD)

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CEPHALOPELVIC DISPROPORTION (CPD)

Cephalopelvic disproportion is a situation in which the fetal head fails to descend through the maternal pelvis, causing the arrest of labor.

  • Though rare, cephalopelvic occurs when a baby’s head or body is too large to enter or pass through the birth canal.
  • CPD accounts for one of the reasons why a woman’s labor fails to progress to delivery making a normal vaginal delivery difficult or nearly impossible to complete.
  • Shorter women and adolescents are more likely to suffer from cephalopelvic disproportion.
  • The American College of Nurse Midwives estimates that CPD occurs 1 in out of 250 pregnancies.
  • A diagnosis of CPD does not mean that you will have the same problem with subsequent deliveries. A study published by the American Journal of Public Health holds that more than 65% of women with a previous diagnosis of CPD in earlier pregnancies were able to deliver vaginally in subsequent deliveries.

CAUSES

The possible causes of cephaloplevic disproportion include:

  • Macrosomia- this implies that the baby is abnormally large. This condition may be due to:
  • Abnormally high maternal sugar levels from gestational diabetes or diabetes mellitus
  • Hereditary factors
  • Postmaturity- when a pregnancy extends past the due date.
  • If the shape of the pelvis is too small or malformed
  • Abnormal fetal position
  • Small pelvis. This is very common in shorter women (heights of 150cm and shorter). A previous case of pelvis disease or trauma may increase the probability of a small pelvis.

SYMPTOMS

Prolonged labor – CPD may cause a situation where labor does not progress.

Large fundal height– this is the distance from the mother’s pubic bone to the top of the mother’s uterus. This is the measure of the size of the uterus and can be used to assess if the child suffers from macrosomia.

A higher volume of amniotic fluid:  An amniotic fluid is a clear, slightly yellowish that surrounds and protects a baby while in the uterus. A higher than normal volume of this may indicate that the child is abnormally large.

DIAGNOSIS AND TREATMENT

DIAGNOSIS

Pelvimetry  to evaluate the baby’s position in the womb, the tissues surrounding the  mother and her baby and the size of the pelvis

Ultrasound to examine the shape and size of the child’s head.

If the diagnosis suggests a case of CPD, a doctor will examine the woman for various risk factors such as testing her blood glucose to check for gestational diabetes and other risk factors associated with the condition.

To monitor the well-being of the abnormally large baby, the doctor may also conduct nonstress testing.

TREATMENT

If CPD has been confirmed and a vaginal birth is not possible, the doctor will order a cesarean section (C-section).

If vaginal delivery is possible and C-section would be harmful to the child, the mother may be asked to change her position. She may have to squat or assume another upright position, this can increase the pelvic capacity by 30%.

A child’s head might get stuck in the birth canal due to CPD, to free the head, the doctor may have to cut the woman’s pubic bone in a process called symphysiotomy. This is done during a vaginal birth.

After a safe delivery, the child should be assessed for birth injuries and low blood sugar.

As the child gets older, the child should be checked for CPD-related complications such as insulin resistance, or obesity.