Cephalopelvlc ulsproporLlon

ueflnlLlon

ulsproporLlon beLween slze of feLal head and Lhe pelvlc dlameLer leLal head LhaL ls Loo large llke
hydrocephalus whlle Lhe maLernal pelvls ls small 1hls ls also Lermed as feLopelvlc dlsproporLlon 1haL
resulLs ln fallure Lo progress ln labor

Causes

O lncreased leLal WelghL
4 Iery large baby due Lo heredlLary reasons a baby whose welghL ls esLlmaLed Lo be
above 3 kgs or 10 pounds
4 9osLmaLure baby when Lhe pregnancy goes above 42 weeks
4 ables of women wlLh dlabeLes usually Lend Lo be blg
4 ables of moLhers who have had a number of chlldren each succeedlng baby Lends Lo
be larger and heavler
O leLal 9oslLlon
4 cclplLoposLerlor poslLlon ln Lhls poslLlon Lhe feLus faces Lhe moLhers abdomen
lnsLead of her back
4 row presenLaLlon
4 lace presenLaLlon
O 9roblems wlLh Lhe 9elvls
4 mall pelvls
4 bnormal shape of Lhe pelvls due Lo dlseases llke rlckeLs osLeomalacla or Luberculosls
4 bnormal shape due Lo prevlous accldenLs
4 1umors of Lhe bones
4 Chlldhood pollomyellLls affecLlng Lhe shape of Lhe hlps
4 CongenlLal dlslocaLlon of Lhe hlps
4 CongenlLal deformlLy of Lhe sacrum or coccyx
8lsk lacLors
Lxcesslve feLal slze or macrosomla
MaLernal dlabeLes melllLus
beslLy
PeredlLy
MulLlparlLy Lach succeedlng baby(up Lo abouL Lhe 3
Lh
baby) Lends Lo be larger
9osLmaLurlLy
MaLernal pelvls ls Loo small
9elvlc Lype ndrold or 9laLypellold







9hyslcal ssessmenL durlng labor




Lack of leLal head engagemenL

ulagnosLlc 1esL
1 Cllnlcal 9elvlmeLry 1he assessmenL of Lhe slze of Lhe pelvls ls made manually by examlnlng
Lhe pelvls and palpaLlng Lhe pelvlc bones by vaglnal examlnaLlon lL ls usually carrled ouL afLer
37 weeks of pregnancy or aL Lhe Llme of Lhe onseL of labor
1he enLlre bony arch of Lhe moLhers pelvls lncludlng Lhe sacrum Lhe sacrococcygeal [olnL
Lhe sacrosclaLlc noLch Lhe lschlal splnes Lhe lllopecLlneal llnes and Lhe publc arch are
palpaLed and an assessmenL of Lhe slze of Lhe pelvls made 1he dlameLer of Lhe pelvls ls
measured wlLh Lhe lndex and mlddle flngers of Lhe hand
2 1esL resulL of measuremenLs LhaL lndlcaLes C9u nLeroposLerlor dlameLer 11cm wlLh
maxlmum 1ransverse dlameLer of 12cm or less (lnleL conLracLlon) / 1ransverse dlameLer aL
ouLleL ls 11cm
2 ulLrasound 1he esLlmaLlon of Lhe babys slze can be made by ulLrasonogram and an
assessmenL of poLenLlal C9u can be made when Lhe resulLs are compared wlLh Lhe
cllnlcal pelvlmeLry ulLrasonography reveals larger Lhan usual feLal head




1reaLmenL
1 9osslble Lrlal of laborlf pelvlc measuremenLs are borderllne or [usL adequaLe especlally Lhe
lnleL measuremenL and Lhe feLal lle and poslLlon are good 1rlal of labor may be conLlnued lf
descenL of presenLlng parL and dllaLaLlon of cervlx are occurlng
2 Cesarean dellverylf labor doesn'L progress aL all and compllcaLlon develops

nurslng lnLervenLlons

1 lnsLrucL paLlenL Lo malnLaln her prenaLal vlslL schedule so LhaL pelvlc measuremenLs are Laken and
recorded before week 24 of pregnancy Lspeclally Lhe prlmlgravldas

2 9oslLlon Lhe moLher ln a varleLy of ways LhaL lncrease pelvlc dlameLer Llke slLLlng and squaLlng LhaL
lncreases Lhe ouLleL dlameLer and may be effecLlve when Lhere ls fallure of or slow feLal descenL

3 MonlLor progress of Lrlal of labor lf afLer 6 Lo 12 hours adequaLe progress of labor can'L be
documenLed or lf feLal dlsLress occurs prepare LhaL woman for cesarean blrLh

4 Lxplaln necesslLy of cesarean blrLh lf necessary lnform boLh Lhe paLlenL and supporL person LhaL a
cesarean blrLh lsn'L an lnferlor meLhod 8emlnd Lhem LhaL lL's an alLernaLlve meLhoda meLhod of
cholce Lo ensure blrLh of Lhe feLus llowlng Lhem Lo achleve Lhelr goal of a healLhy moLher and a
healLhy chlld

3 9rovlde emoLlonal supporL ffer supporL also Lo Lhe supporL persons of Lhe paLlenL












Cephalopelvlc ulsproporLlon (C9u)
Lmall
9rlnL
1he accuraLe deflnlLlon of cephalopelvlc dlsproporLlon (C9u) ls when a babys head or body ls Loo large Lo flL Lhrough Lhe moLher's pelvls lL
ls belleved LhaL Lrue C9u ls rare buL many cases of fallure Lo progress" durlng labor ls glven a dlagnosls of C9u When an fnnf
dlagnosls of C9u has been made Lhe safesL Lype of dellvery for moLher and baby ls a cesarean dellvery
WhaL causes cephalopelvlc dlsporoprLlon (C9u)?
1he posslble causes of cephalopelvlc dlsproporLlon (C9u) lnclude
O Large baby due Lo
4 PeredlLary facLors
4 ulabeLes
4 9osLmaLurlLy (sLlll pregnanL afLer due daLe has passed)
4 MulLlparlLy (noL Lhe flrsL pregnancy)
O bnormal feLal poslLlons
O mall 9elvls
O bnormally shaped pelvls
Pow ls cephalopelvlc dlsproporLlon dlagnosed (C9u)?
1he dlagnosls of cephalopelvlc dlsproporLlon ls ofLen used when labor progress ls noL sufflclenL and medlcal Lherapy such as use of oxyLocln
ls noL successful or aLLempLed C9u can rarely be dlagnosed before labor beglns even lf Lhe baby ls LhoughL Lo be large or Lhe mom's pelvls
ls known Lo be small uurlng labor Lhe baby's head molds and Lhe pelvls [olnLs spread creaLlng more room for Lhe baby Lo pass Lhrough Lhe
pelvls ulLrasounds are used Lo esLlmaLe feLal slze however Lhey are noL 100 accuraLe ln deLermlnlng feLal welghL physlcal examlnaLlon
LhaL measures pelvlc slze can ofLen be Lhe mosL accuraLe aL deLermlnlng a dlagnosls of C9u lf a Lrue dlagnosls of C9u cannoL be made Lhe
use of oxyLocln ls ofLen admlnlsLered Lo see lf Lhls aldes ln labor progressslon or change ln feLal posLlonlng
WhaL abouL fuLure pregnancles?
Cephalopelvlc dlsproporLlon ls a rare occurance ccordlng Lo Lhe merlcan College of nurse Mldwlves(CnM) C9u occurs ln 1 ouL of 230
pregnancles lf you have been dlagnosed wlLh C9u Lhls does noL auLomaLlcally mean LhaL you wlll have Lhls problem ln fuLure dellverles
ccordlng Lo a sLudy publlshed by Lhe merlcan !ournal of 9ubllc PealLh over 63 of women who had been dlagnosed wlLh C9u ln
prevlous pregnancles were able Lo dellver vaglnally ln subsequenL pregnancles
1hls ls when Lhe head ls Loo large for Lhe pelvls lL ls a common cause of obsLrucLed labour 9osslble causes of cephalopelvlc dlsproporLlon
lnclude
O large baby (absoluLe dlsproporLlon)
4 heredlLary facLors
4 posLmaLurlLy
4 dlabeLes
4 mulLlparlLy each succeedlng baby (up Lo abouL Lhe 3Lh baby) Lends Lo be larger and heavler
O abnormal poslLlons (relaLlve dlsproporLlon)
4 Lhe normal foeLus dellvers ln Lhe occlplLoanLerlor poslLlon lf Lhe head ls well flexed ln Lhls poslLlon Lhen Lhe head ls
presenLs wlLh Lhe subocclplLobregmaLlc dlameLer (93 cm) and easlly passes Lhrough Lhe pelvls Lher poslLlons eg
occlplLoposLerlor brow presenL a much larger dlameLer (113 cm and 133 cm respecLlvely)
O small pelvls
O abnormal shape Lo pelvls eg rlckeLy or Lrefoll pelvls
O abnormallLy of Lhe genlLal LracL
4 cervlx congenlLal rlgldlLy posLsurglcal scarrlng
4 vaglna congenlLal sepLum
4 flbrolds may rarely cause obsLrucLlon Lo labour