INTRODUCTION REPORT

CEPHALOPELVIC DISPRORTION (CPD)

To fulfill the task of maternity nursing clinic practice 1

Name : Nadia Tara Dila

NPM : 1914201310078
Semester : III
Hospital : Islam Banjarmasin
Group : 1 Bilingual
Clinical Advisor : Nurhikmah, S.Kep.,Ns
Academic counselors : Esme Anggraini, Ns.,M.Kep

BILINGUAL NURSING STUDY PROGRAM

FACULTY OF NURSING AND HEALTH SCIENCE

MUHAMMADIYAH BANJARMASIN UNIVERSITY 2020-2021

 STUDENT IDENTITY

NAME : Nadia Tara Dila

NPM : 1914201310077

HOME BASE : Rumah Sakit Islam Banjarmasin

CI : Nurhikmah, S.Kep.,Ns

CT : Esme Anggraini, Ns.,M.Kep

HP/WA : 081254434003

ALAMAT : Jl. Belitung darat. Gg bina warga, No. 397

PRODI : S1 KEPERAWATAN BILINGUAL

 INTRODUCTION REPORT: CEPHALOPELVIC DISPRORTION (CPD)

INTRODUCTION REPORT

1. Definition
Cephalopelvic Disproportion (CPD) is a medical diagnosis used when a baby's head is deemed
too large to fit past the mother's pelvis.
Cephalopelvic disproportion is a condition that describes the incompatibility between the fetal
head and the mother's pelvis so that the fetus cannot pass through the vagina.
Cephalopelvic disproportion is caused by a narrow pelvis, a large fetus or a combination of both
Cephalopelvic disproportion is a condition that describes a mismatch between the fetal head and
the pelvis of the mother so that the fetus cannot pass through the vagina.
Cephalopelvic Disproportion (CPD) is a medical diagnosis used when a baby's head is deemed
too large to fit past the mother's pelvis. Often times, this diagnosis is made after the woman
has been toiling for some time, but other times, it is entered into the woman's medical record
before she is even a laborer. A misdiagnosis of CPD accounts for the many unnecessary C-
sections performed in North America and around the world each year. This diagnosis does
not have to impact a woman's future childbearing decisions. Many steps can be taken by
pregnant women to increase their chances of vaginal delivery.

2. Etiology
The causes that can cause pelvic abnormalities can be divided as follows:
a. Abnormalities due to growth disorders
1) The entire narrow pelvis: all small sizes
2) Hip picak: narrow back face size, usual cross size
3) Small narrow hips: all small sizes but especially the back face size
4) Pelvic funnel: ordinary upper pelvis, narrow pelvic doors.
5) Pelvis split: open symphyse

b. Abnormalities due to disease of the pelvis or joints

1) Pelvic rachitis: hip hip, narrow pelvis, whole narrow pelvis and others
2) Pelvic osteomalacci: narrow transverse pelvis
3) Inflammation of articulatio sacroilliaca: narrow pelvis oblique
c. Pelvic abnormalities caused by spinal abnormalities
1) Kyphose in the lumbar region causing the pelvis funnel
2) Sciliose area of the stilt bone causes a narrow pelvis tilt.
d. Pelvic abnormalities caused by lower limb abnormalities Coxitis, luxatio, atrophy. One
member causes a narrow pelvis to tilt. e. fracture of the pelvis which is the cause of pelvic
abnormalities (www.tabloid nakita.com/2009)

3.      Patofisiologi
           
The pelvic bones consist of the coccyx, sacral, and coccyx bones. The os koksa can be divided into os
ilium, os ischium, and os pubis. These bones are connected to each other. In front there is a
connection between the two right and left pubic os, called the symphysis. Behind the sacro-iliac
articulation, which connects the sacral os to the os ilium. Below is the sacro-coccygeal articulation
that connects the sacral os (tl pelvis) and the coccyx os (tl.tungging).
In women, outside of pregnancy this articulation allows only a slight shift, but in pregnancy and
delivery it can shift further and more loosely, for example, the tip of the coccyx can move backward
up to about 2.5 cm. This can be done if the tip of the coccyx.
protrudes forward at delivery, and on expulsion of the fetal head with the cunam cunam the tip of the
coccyx can be pushed back. Functionally, the pelvis consists of two parts, namely the pelvis major
and pelvis minor. Major pelvis
is the part of the pelvis that is located above the linea terminalis, also called the false pelvis. The part
that lies below the linea terminalis is called the pelvis minor or true pelvis. In the space formed by the
major pelvis, there are abdominal organs besides that the major pelvis is the place where the muscles
and ligaments attach to the body wall. Whereas in the space formed by the minor pelvis there are
parts of the colon, rectum, bladder, and in women there are the uterus and ovaries. In the pelvic space
we also find the pelvic diaphragm which is formed by the levatorani and coccygeal muscles.
a. Hip Size
1) Upper Pelvic Door
The upper door of the pelvis is formed by the promontorium of the corpus vertebrae of the sacrum,
linea innominata, and the upper edge of the symphysis. The diagonal conjugate is the distance from
the lower edge of the symphysis to the promontorium. Clinically, the diagonal conjugate can be
measured by inserting the closed index and middle fingers up the entire anterior surface of the sacrum,
palpable promontorium as a bony prominence. Keeping the fingers attached to the promontorium, the
hand in the vagina is raised until it touches the arcus pubis and is marked with the index finger of the
left hand. The distance between the fingertips on the promontorium to the point indicated by the
index finger is the length of the diagonal conjugate.
Conjugata vera is the distance from the upper edge of the symphysis to the promontorium which is
calculated by subtracting the conjugate diagonalis by 1.5 cm, its length is approximately 11 cm.
Obstetric conjugates are the most important conjugates, namely the distance between the middle part
of the symphysis and the promontorium. The difference between conjugata vera and conjugata
obstetrics is very small.
2) Middle Pelvic (Pelvic Cavity)
This pelvic chamber has the largest size. Clinical measurements of the mid-pelvis cannot be obtained
directly. There is a narrowing at the level of the ischial spine, so it is important in dystocia after head
engagement. The distance between the two spines, which is known as the interspinarum distancy, is
the smallest pelvic distance, which is 10.5 cm. The anteroposterior diameter at the height of the
isciadic spine measures 11.5 cm. The posterior sagittal diameter, the distance between the sacrum and
the interspinarum diameter line is 4.5 cm. 3.4.
3) Lower Pelvic Door
 The door below the pelvis is not a flat plane but consists of two triangles with the same base, namely
the line connecting the left and right ischial tubes. The pelvic gates that can be obtained through
clinical measurement are the distance between the two iscii tuberosity or tuberum (10.5 cm), the
distance from the tip of the sacrum to the middle of the tuberal dystia or posterior sagittal diameter
(7.5 cm), and the distance between the edges. below the symphysis to the end of the sacrum (11.5
cm).

4.      Komplikasi
When labor with pelvic disproportionate phallos is allowed to take place alone when necessary.
Taking the right action, causing danger to the mother and the fetus (Sarwono)
1) Danger to mother
a. Prolonged labor, often accompanied by rupturing of the membranes at the small opening, can
lead to dehydration as well as acidosis and intrapartum infection.
b. With a firm, moderate progression of the fetus in a restrained birth canal, there can be
stretching of the lower segment of the uterus and the formation of a pathologic retraction loop
(Bandl). This condition is known as threatening uterine rupture. If measures are not taken to
reduce the stretch immediately, uterine rupture can result
c. With labor not progressing due to disproportionate pelvic cephalopods the birth canal is at
one place subject to prolonged pressure between the fetal head and the pelvis. This results in
circulatory disturbances with consequent ischemia and subsequent necrosis at the site.
Several days post partum there will be cervical vesic fistula, or vesico vaginalis fistula or
recto vaginalis fistula.
2) Harm to the fetus
a. Patuslama can increase perinatal mortality, if coupled with intrapartum infection
b. Prolasus Funikuli, if it occurs, is very dangerous to the fetus and requires childbirth if he is
still alive.
c. With cephalopelvic disproportion the fetal head can pass through the pelvic barrier by means
of moulage which can be experienced by the fetal head without adverse consequences to
some extent. However, if these limits are exceeded, tearing of the tentorium cerebelli and
intracrahial bleeding occurs
d. Subsequently pressure by the promontorium or sometimes by symfiction in the hip fracture
causes injury to the tissue above the fetal skull

5. Management
a. Trial Labor
After assessing the size of the pelvis and the relationship between the head of the fetus and the
pelvis, it can be estimated that the delivery can take place vaginally safely, then trial delivery.
 This method is a test of his strength, accommodation capacity, including moulage because
these factors cannot be known before delivery.
Experimental labor is only performed on the back of the head, not in the breech position,
forehead position, face position, or other location abnormalities. Another rule is that the
gestational age should not be more than 42 weeks because the fetal head is enlarged so that it
is difficult to moulage and there is the possibility that fetal placental dysfunction will
complicate trial delivery.
In a large fetus, difficulties in bearing the shoulder cannot always be predicted beforehand. If
during the birth process the baby's head has come out while the delivery of the shoulder is
difficult, it is better if a sufficiently wide medioateral episiotomy is carried out, then the nose
and mouth of the fetus are cleaned, the head is pulled steeply downward carefully and of
course with measured force. If this does not work, you can rotate the baby's body in the
pelvic cavity, so that it becomes the front shoulder which was previously the rear shoulder
and is born under the symphysis. If this method still does not work, the helper inserts his
hand into the vagina, and tries to deliver the fetus by moving his chest in front. To deliver
the left arm, the helper uses his right hand, and vice versa. Then the front shoulders are
turned to the oblique diameter of the pelvis to give birth to the front shoulders.
There are two kinds of trial labor, namely trial of labor and test of labor. The trial of labor is
similar to the trial labor above, whereas the test of labor is actually the final phase of the trial
of labor because it only starts at complete opening and ends 2 hours later. Currently the test
of labor is rarely used because it is usually incomplete opening in a narrow-hump labor and
there is a high mortality of children in this way.
The success of the trial delivery is that the child can be born by vaginal birth or assisted with
extraction with the condition of the mother and child both. Trial labor is terminated if the
opening is not progressing or not, the condition of the mother or child is not good, there is a
bandl circle, after complete opening and rupture of the head does not enter PAP within 2
hours even though his is good, as well as in failed forceps. In this situation a cesarean section
is performed.

b. Sesarea Section

Elective cesarean section is performed in severe pelvic narrowing with term pregnancy, or
marked sephalopelvic disproportion. Section can also be performed on mild pelvic
stagnation if there are complications such as old primigravida and irreparable fetal
positioning.
Secondary cesarean section (after delivery for a period of time) was performed because trial
delivery was considered a failure or there was an indication for completion of labor as soon
as possible while the requirements for vaginal delivery had not been met.
c. Symphisiotomy
This action is performed by separating the left and right pelvis at the symphysis. This action is
not done anymore.
d. Craniotomy and Kleidotomy
In fetuses that have died can be done craniotomy or kleidotomy. If the pelvis is so narrow that
the fetus cannot be delivered, cesarean section is performed.
Actually the pelvis is only one of the factors that determine whether the child can be born
spontaneously or not, in addition to many other factors that play a role in the prognosis of
labor. If the conjugata vera is 11 cm, it can be ascertained that normal labor, and if there is
difficulty in labor, it is definitely not caused by pelvic factors. For CV less than 8.5 cm and
full-term children it is impossible to pass the pelvis.
1) CV 8.5 - 10 cm is subject to trial delivery which may end in spontaneous delivery or by
vacuum extraction, or is helped by secondary caesarean section for other obstetric indications
2) CV = 6 -8.5 cm performed primary SC
3) CV = 6 cm performed absolute primary SC.
Besides the things mentioned above also depends on:
a. His or energy that drives the child.
b. Fetal size, presentation and fetal position
c. Hip shape
d. The age of mother and child is precious
e. Mother's disease

6. Supporting Examination
1) Radrology Examination
For Pelvimetry, 2 photographs were made
a. Photo of the upper doorway
The mother is in a half-sitting position (Thoms), so that the X-ray tube is perpendicular to the
upper pelvis
b. Lateral photo
The mother is in a standing position, the X-ray tube is directed horizontally against the side
virtual trochanter
7. Nursing Diagnosis
1) Lack of knowledge related to inadequate information about the care procedures before and
after delivery through SC surgery
2) High risk of injury related to physiological function and tissue injury.
3) Anxiety associated with threats to self-concept.
4) Situational low self-esteem is associated with feeling a failure in life.

8.       Nursing Care Planning

1)    
Dx: Lack of knowledge related to lack of information about procedures and prenatal care through SC
surgery.
Destination :
Clients can understand about the delivery procedure via SC and are willing to cooperate in pre-
surgical preparation
Result Criteria:
a. The client understands the procedure for delivery via SC
b. The client is willing to cooperate in pre-surgical preparation.
Intervention:
a. Discuss with clients and loved ones the reasons for SC.
b. Describe the preoperative procedure and the possible risks that can occur (Informed Consent).
c. Testify in the process of signing an action agreement.
d. Get basic vital signs.
e. Collaboration in Lab testing. (DPL, electrolytes, blood group and urine).
2) Dx: High risk of injury related to physiological function and tissue injury.
Destination:
High risk of injury and injury does not occur.
Result Criteria:
Clients are able to implement behaviors to reduce the risk of injury and self-protection so that they
can be free from complications.
Intervention:
a. Observe vital signs.
b. Observe dressings for excessive bleeding.
c. Pay attention to the catheter, number of lochia and consistency of the fundus.
d. Monitor fluid intake and urine output.
e. Encourage foot / ankle exercises and early ambulation.
f. Instruct clients to always change body position (sitting, lying in a flat position).
g. Observe the surgical wound area (whether there has been a change in the direction of healing or
signs of infection).
h. Observe the lower limb area for signs of thromboplebitis
i. Give intravenous fluids according to the program.
j. Check Hb, Ht postoperatively compare with preoperative levels.

3) Dx: Anxiety related to threats to self-concept.

Purpose: Anxious does not occur.
Result criteria:
a. The client understands, understands and is able to express anxiety and is able to identify ways to
reduce the level or eliminate anxiety independently.
b. The client says that anxiety is under control and is in a state that can be managed.
c. The client looks relaxed and can sleep and rest enough.
Intervention:
a. Encourage clients to express feelings.
b. Help clients identify common coping mechanisms and develop coping strategies as needed.
c. Provide accurate information abonew the condition of the client and the baby.
d. Instruct the client to frequent contact with the baby as soon as possible.
4) Dx: Situational low self-esteem is associated with feeling a failure in life.
Destination:
Feelings of situational low self-esteem do not occur.
Result criteria:
a. Clients are able to discuss problems related to roles and perceptions of birth experiences
b. Client or partner and able to express positive self-expectations.
Intervention:
a. Determine the client's emotional response or preference to the SC birth.
b. Review participation and role of client / partner in the birth experience.
c. Tell the client about the similarities between CS and vaginal delivery.

DAFTAR PUSTAKA

Prawirohardjo, Sarwono. 2002. Ilmu Kebidanan. Jakarta: Yayasan Bina Pustaka Sarwono

Prawirohardjo
Saifuddin AB. Ilmu Kebidanan Sarwono Prawirohardjo. Edisi Keempat. Jakarta: BP-SP,
2008.
Diambil di http://aangcoy13.blogspot.com/2012/05/askep-cephalopelvic-disproportion-
cpd.html pada tanggal 24 Oktobel 2014 pukul 14.00 WITA
Diambil di http://rumahkitabro.blogspot.com/2010/11/asuhan-keperawatan-cephalo-
pelvik.html pada tanggal 24 Oktobel 2014 pukul 14.00 WITA

Banjarmasin, 8 Feberuari 2021

 College student

Nadia Tara Dila

NPM. 1914201310078

To agree

Clinical Advisor Academic Advisor

Nurhikmah, S.Kep.,Ns Esme Anggraini, Ns.,M.Kep

NIP. 1096 NIDN. 1131129002

Student name : Nadia Tara Dila

NPM : 1914201310078

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Jum'at , 5 Report -change the report by lenguange
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