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INTRODUCTION
CEPHALOPELVIC DISPROPORTION
This can be because of a small pelvis and an average sized fetus, a large
baby with an average sized pelvis or because of malposition of the fetal
head.
CPD is very frequently diagnosed and is a very common indication of
cesarean sections, especially when there is failure to progress in labor.
It is very difficult to diagnose CPD before a women has started her labor
pains since it is very difficult to anticipate how well the fetal head and
the maternal pelvis will adjust and mould to each other.
CPD is one of the commonest cause of different complications in labor,
including prolonged labor, fetal distress, and delayed second stage .
DYSTOCIA
1) Cervical Dystocia
In cervical dystocia, the cervix fails to dilate during labor.
2) Shoulder dystocia
During the peripartum period the infant's head usually lies to the
left and then rotates to the occipito-anterior position, and the head is
delivered first. Following this, the shoulders lie in the
anteroposterior position and then pass the pelvic brim. However, if
the shoulders become stuck at this position, the infant can inhale, as
the mouth and nose are out of the vagina; however, the chest cannot
expand as it is stuck in the pelvic brim. This will rapidly lead to
hypoxia and death of the fetus if not delivered quickly. Usually it is
the anterior shoulder which impacts on the maternal symphysis. Less
commonly, the posterior shoulder impacts on the sacral promontory.
FETAL DISTRESS
II. INCIDENCE
CPD INCIDENCE
DYSTOCIA INCIDENCE
FETAL DISTRESS
The exact incidence of fetal distress is uncertain, but estimates range from
one in every 25 births to one in every 100 births.
III. RISK FACTORS
CAUSES OF CPD
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.
Childhood poliomyelitis affecting the shape of the hips.
Congenital dislocation of the hips.
Congenital deformity of the sacrum or coccyx.
CAUSES OF DYSTOCIA
Anemia
Hydramnios or Oligohydramnios (a condition in which there is a lower
level of amniotic fluid)
Pregnancy induced hypertension or Pre-eclamptic toxemia (PET)
Post term pregnancy in which the pregnancy is of more than 42 weeks
duration.
Intrauterine Growth Retardation.
Signs of CPD
One of the main signs of cephalopelvic disproportion is that the woman
will fail to progress in her pregnancy. This means that she will continue to be
pregnant without any signs that labor is a possibility.
V. MEDICAL MANAGEMENT
DIAGNOSIS OF CPD
The diagnosis of cephalopelvic disproportion is often used when labor
progress is not sufficient and medical therapy such as use of oxytocin is not
successful or not attempted. CPD can rarely be diagnosed before labor begins if the
baby is thought to be large or the mothers pelvis is known to be small.
Ultrasound is used in estimating fetal size but not totally reliable for
determining fetal weight. A physical examination that measures pelvic
size can often be the most accurate method for diagnosing CPD. If a true
diagnosis of CPD cannot be made, oxytocin is often administered to help
labor progression. Alternatively, the fetal position is changed.
Clinical Pelvimetry. The assessment of the size of the pelvis is made
manually by examining the pelvis and palpating the pelvic bones by
vaginal examination. It is usually carried out after 37 weeks of
pregnancy or at the time of the onset of labor
Radio-logical Pelvimetry. X-rays 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.
Fetal Distress
VI. TREATMENT
CPD TREATMENT
DYSOCIA TREATMENT
Cesarean Delivery
DYSTOCIA
IX. REFERENCES
http://gynaeonline.com/cpd.htm
http://americanpregnancy.org/labor-and-birth/cephalopelvic-disproportion/
http://gynaeonline.com/fetal_distress.htm
http://medical-dictionary.thefreedictionary.com/dystocia
http://www.medicinenet.com/script/main/art.asp?articlekey=3418
http://www.whattoexpect.com/pregnancy/pregnancy-health/complications/fetal-di
stress.aspx
http://www.shoulderdystociainfo.com/anticipated.htm
http://patient.info/doctor/dystocia
http://pregnancytips.org/pregnancy/labor-and-childbirth/cephalopelvic-disproport
ion-signs-and-symptoms/
https://www1.cgmh.org.tw/intr/intr5/c6700/OBGYN/f/web/Dystocia/index.htm