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Client Initials: Name:

Medical Diagnosis: Cephalopelvic Disproportion Date:


eu
DEFINITION: RELATED DIAGNOSTIC TESTS:
The relationship between the measurements of the fetal head and the diameters Ultrasound of fetus to determine presentation and lie.
of the maternal pelvis. Manual exam before labor
CT scan with estimated weight of fetus.

ETIOLOGY: MEDICAL MANAGEMENT:


The birth passage includes the maternal bony pelvis, beginning at the The adequacy of the maternal pelvis for a vaginal birth should be assessed both
pelvic inlet and ending at the pelvic outlet. A narrowed diameter in during and before labor. During the intrapartal assessment, the size of the fetus
these areas can result in CPD if the fetus is larger than the pelvic and its presentation, position, and lie must also be considered.
Frequent assessments of cervical dilation and fetal descent are made.
diameters. If progress ceases, the decision for a cesarean birth is made.

PATHOPHYSIOLOGY: NURSING MANAGEMENT:


Labor is prolonged in the presence of CPD. Membrane rupture can result from Vitals q4hrs or as ordered by doctor.
the force of the unequally distributed contractions being exerted on the fetal Monitor both contractions and fetus continuously.
membranes. Any signs of fetal distress are reported to the CNM or MD immediately
In obstructed labor, in which the fetus cannot descend, uterine rupture can Position mother in ways to increase the pelvic diameters.
occur. With delayed descent, necrosis of maternal soft tissues can result form Sitting or squatting increases the outlet diameters and may aid in fetal descent.
pressure exerted by the fetal head. Eventually, necrosis can cause fistulas from Monitor fetus for signs of hypoxia take appropriate actions if necessary.
the vagina to other nearby structures. Difficult, forceps-assisted births can also
result in damage to maternal soft tissue. Monitor mother and fetus for any signs of distress.
Monitor contractions and EFM or IFM, report any unusual findings.

SIGNS & SYMPTOMS: HEALTH DEVIATION SELF-CARE REQUISITES:


Encourage pt to assume a position that will add in the descent of fetus.
*Prolonged labor
*Cervical dilation and effacement are slow Provide support to client and family members in coping with the stress of a
complicated labor.
*Engagement of the presenting part is delayed
*Adequacy of the maternal pelvis small for size of fetus Encourage pt to drink clear fluids to maintain hydration.
Encourage pt to take cleansing breaths in-between contractions to promote
adequate oxygen exchange for her and baby.

REFERENCE PAGES:
Contemporary Maternal-Newborn Nursing Care, Ladewig, London, Moberly,
Olds
Pgs 488, 489
Tabors Medical Dictionary, Davis, pg 37

eu
DEFINITION: RELATED DIAGNOSTIC TESTS:
Client Initials: Name:
Medical Diagnosis: Cephalopelvic Disproportion Date:
The relationship between the measurements of the fetal head and the diameters Ultrasound of fetus to determine presentation and lie.
of the maternal pelvis. Manual exam before labor
CT scan with estimated weight of fetus.

ETIOLOGY: MEDICAL MANAGEMENT:


The birth passage includes the maternal bony pelvis, beginning at the The adequacy of the maternal pelvis for a vaginal birth should be assessed both
pelvic inlet and ending at the pelvic outlet. A narrowed diameter in during and before labor. During the intrapartal assessment, the size of the fetus
these areas can result in CPD if the fetus is larger than the pelvic and its presentation, position, and lie must also be considered.
Frequent assessments of cervical dilation and fetal descent are made.
diameters. If progress ceases, the decision for a cesarean birth is made.

PATHOPHYSIOLOGY: NURSING MANAGEMENT:


Labor is prolonged in the presence of CPD. Membrane rupture can result from Vitals q4hrs or as ordered by doctor.
the force of the unequally distributed contractions being exerted on the fetal Monitor both contractions and fetus continuously.
membranes. Any signs of fetal distress are reported to the CNM or MD immediately
In obstructed labor, in which the fetus cannot descend, uterine rupture can Position mother in ways to increase the pelvic diameters.
occur. With delayed descent, necrosis of maternal soft tissues can result form Sitting or squatting increases the outlet diameters and may aid in fetal descent.
pressure exerted by the fetal head. Eventually, necrosis can cause fistulas from Monitor fetus for signs of hypoxia take appropriate actions if necessary.
the vagina to other nearby structures. Difficult, forceps-assisted births can also
result in damage to maternal soft tissue. Monitor mother and fetus for any signs of distress.
Monitor contractions and EFM or IFM, report any unusual findings.

SIGNS & SYMPTOMS: HEALTH DEVIATION SELF-CARE REQUISITES:


Encourage pt to assume a position that will add in the descent of fetus.
*Prolonged labor
*Cervical dilation and effacement are slow Provide support to client and family members in coping with the stress of a
complicated labor.
*Engagement of the presenting part is delayed
*Adequacy of the maternal pelvis small for size of fetus Encourage pt to drink clear fluids to maintain hydration.
Encourage pt to take cleansing breaths in-between contractions to promote
adequate oxygen exchange for her and baby.

REFERENCE PAGES:
Contemporary Maternal-Newborn Nursing Care, Ladewig, London, Moberly,
Olds
Pgs 488, 489
Tabors Medical Dictionary, Davis, pg 37