CEPHALOPELVIC DISPROPORTION (CPD) DEFINITION: Exists when the capacity of the pelvis is inadequate to allow the fetus to negotiate

the birth canal. This may be due to a small pelvis, a nongynecoid pelvic formation, and a large fetus. ETIOLOGY: The birth passage includes the maternal bony pelvis, beginning at the pelvic inletand ending at the pelvic outlet. A narrowed diameter in these areas can result in CPD if the fetus is larger than the pelvic diameters. TYPES OF FEMALE PELVICS 1. 2. 3. 4. The The The The gynecoid pelvis- round shape android pelvis-heart shape anthropoid pelvis-long oval platypelloid pelvis-kidney shape
CAUSES OF CEPHALOPELVIC DISPROPORTION

INCREASED FETAL WEIGHT:  Very large baby due to hereditary reasons - a baby whose weight is estimated to be above 5 Kgs or 10 pounds .  Postmature baby - when the pregnancy goes above 42 weeks.  Babies of women with diabetes usually tend to be big. FETAL POSITION:  Brow presentation  Face presentation. PROBLEMS WITH THE PELVIS:  Small pelvis.  Abnormal shape of the pelvis due to diseases like rickets,osteomalacia or tuberculosis.  Abnormal shape due to previous accidents.  Tumors of the bones. SIGNS & SYMPTOMS:  *Prolonged labor  *Cervical dilation and effacement are slow  *Engagement of the presenting part is delayed  *Adequacy of the maternal pelvis small for size of fetus DIAGNOSTIC TESTS:  Clinical Pelvimetry: The assessment of the size of the pelvis is made manually by examining the pelvis and palpating the pelvic bonesby vaginal examination. It is usually carried out after 37 weeks of pregnancy or at the time of the onset of labor.  Radiological Pelvimetry: Xrays or CT scans are taken of the pelvis in different angles and views and the pelvic diameter measured. But this method is not done nowadays as it can cause radiation toxicity to the baby.

 Ultrasound of fetus to determine the diameter of fetal skull and to determine presentation, presenting part, position, flexion and degree descent of fetus. MEDICAL MANAGEMENT: The adequacy of the maternal pelvis for a vaginal birth should be assessed both during and before labor. During the intrapartal assessment, the size of the fetus and its presentation, position, and lie must also be considered. Frequent assessments of cervical dilation and fetal descent are made. If progress ceases, the decision for acesarean birth is made. SURGICAL TREATMENT If the surgeon is absolutely certain that there is cephalopelvic disproportion, then a Cesarian section is the only option to deliver the baby. NURSING MANAGEMENT:  Vital signs q4hrs or as ordered by doctor.  Monitor both contractions and fetus continuously. .  Sitting or squatting increases the outlet diameters and may aid in fetal descent.  Monitor fetus for signs of hypoxia take appropriate actions if necessary.  Monitor mother and fetus for any signs of distress.  Encourage pt to drink clear fluids to maintain hydration