Cephalopelvic disproportion

By
R. Vijayalakshmi
IIIrd BHMS

TYPES OF PELVIS
GYNECOID
ANDROID
PLATYPELLOID
ANTHROPOID

GYNECOID PELVIS
CLASSIC FEMALE TYPE
SEEN IN 50% FEMALE

Contd…
CHARACTERISTICS
 INLET:
ROUND
 TRANSVERSE DIAMETER:
WIDE
 SIDE WALLS:
STRAIGHT

Contd…
 ISHIAL SPINE:
AVERAGE PROMINENCE
 SACRO-SCIATIC NOTCH:
WELL ROUNDED
 SACRUM:
WELL CURVED
 SUPRA PUBIC ARCH:
SPACIOUS WITH 90°.

ANDROID PELVIS
TYPICAL MALE TYPE.
SEEN IN 30% FEMALE.

Contd...
CHARACTERISTICS
INLET:
TRIANGLE
TRANSVERSE DIAMETER:
NARROW THAN GYNECOID
SIDE WALLS:
CONVERGENT

Contd...
 SACRUM:
SHALLOW CURVE
LONG & NARROW
 SUB PUBIC ARCH:
NARROW

ANTHROPOID
PELVIS
RESEMBLES APE PELVIS.
SEEN IN 20% FEMALES.

A
N
T
H
R
O
P
O
I
D
P
E
L
V
I
S

Contd...
CHARACTERISTICS
 INLET:
OVAL
 SIDE WALLS:
NOT CONVERGENT
 ISHIAL SPINE:
CLOSER

Contd...
LARGE
 SUB PUBIC ARCH:
NARROW

PLATYPELLOID
PELVIS
FLATTEND GYNECOID PELVIS.
SEEN IN 3% FEMALE.

Contd...
CHARACTERISTICS
 INLET:
OVAL
 SIDE WALLS:
STRAIGHT

DEFINITION:
CEPHALO PELVIC DISPROPORTION
IS THE DISPARITY IN RELATION
BETWEEN FETAL HEAD &
MATERNAL PELVIS.
INCIDENCE:
2 IN 250 PREGNANCY.

CAUSES:
 NUTRITIONAL DEFICIENCY.
 PELVIC DISEASE / INJURY.
 DEVELOPMENTAL DEFECTS.
 BIG BABY
 MALPRESENTATION

DEGREE OF DISPROPORTION
SEVERE DISPROPORTION
IN THIS THE OBSTETRIC
CONJUGATE IS <7.5 cm .
BORDERLINE DISPROPORTION
IN THIS OBSTETRIC
CONJUGATE IS BETWEEN 9.5 & 10cm .

OBSTETRICCONJUGATE
THE SHORTEST PELVIC DIAMETER
THROUGH WHICH THE FETAL HEAD MUST
PASS DURING BIRTH, MEASURED FROM
SACRAL PROMONTORY TO A POINT A FEW
MILLIMETERS FROM THE TOP OF PUBIC
SYMPHYSIS.

INVESTIGATIONS:
 PELVIMETRY
 CEPHALOMETRY
 CT PELVIS
 MRI
 USG

MANAGEMENT OF CPD
IN BORDER LINE CPD
VAGINAL DELIVERY AT TERM.
IN SEVERE CPD
 ELECTIVE CS AT TERM
 TRIAL LABOUR

TRIAL LABOR
IT IS THE CONDUCTION OF SPONTANEOUS LABOR IN A
MODERATE DEGREE OF DISPROPORTION IN AN INSTITUTION
UNDER SUPERVISION WITH WATCHFUL EXPECTENCY
HOPING FOR VAGINAL DELIVERY
OR
IT IS A TEST LABOR ALLOWING THE PATIENT TO ENTER INTO
ACTIVE LABOR PUTTING ALL VARIABLE [POWER,PASSAGE & PASSENGER]
INTO TEST & DETERMINE WHETHER VAGINAL DELIVERY IS POSSIBLE.

THE PROGRESS OF LABOUR
IS MAPPED WITH PARTOGRAPH
TO ACCESS THE
 PROGRESSIVE DESCENT OF HEAD.
 PROGESSIVE DILATATION OF
CERVIX.

AFTER RUPTURE OF MEMBRANE ,
PELVIS EXAMINATION IS TO BE
DONE TO
 EXCLUDE CORD PROLAPSE
 NOTE THE COLOR OF LIQUOR
 NOTE THE CONDITION OF
CERVIX INCLUDING PRESSURE OF
PRESENTING PART ON CERVIX.

SUCCESSFUL TRIAL
A TRIAL LABOR IS SAID TO BE
SUCCESSFUL IF A HEALTHY BABY
IS BORN VAGINALLY, OR BY
FORCEPS OR VENTOSE WITH THE
MOTHER IN GOOD CONDITION.

FAILURE OF TRIAL
A TRIAL LABOR IS SAID TO
BE A FAILURE IF THE DELIVERY
IS BY CESAREAN SECTION OR
DELIVERY OF DEAD BABY
BY CRANIOTOMY.

FAVOURABLE FACTORS
 FLAT PELVIS IS BETTER THAN
ANDROID.
 VERTEX PRESENTATION.
 MINOR DEGREE OF CONTRACTION.
 INTACT MEMBRANES TILL FULL
DILATATION.
 GOOD UTERINE CONTRACTION.
 EMOTIONAL STABILITY OF WOMAN.

CONTRAINDICATIONS:
 PRIMIGRAVIDA
 MAL PRESENTATION
 POST MATURITY
 POST CAESEREAN PREGNANCY
 PRE-ECLAMPSIA
 DIABETES
 LACK OF FACILITIES FOR C-SECTION

UNFAVOURABLE FACTORS
 APPEARANCE OF ABNORMAL UTERINE
CONTRACTION.
 CERVICAL DILATATION <1cm/hr.
 DESCENT OF FETAL HEAD <1cm/hr.
 ARREST OF CERVICAL DILATATION
AND NON DESCENT OF FETAL HEAD
INSPITE OF OXYTOCIN THERAPY.
 FETAL DISTRESS.

ADVANTAGES:
 LOWER INCIDENCE OF CESAREAN
SECTION.
 A SUCCESSFUL TRIAL ENSURES
WOMEN A GOOD FUTURE OBSTETRICS.

DISADVANTAGES:
 MAY END IN FULL DILATATION
OF CERVIX.
 INCREASED FETAL MORTALITY
& MORBIDITY.
 IN FAILED TRIAL INCREASED
OPERATIVE RISKS.

HOW LONG TO CONTINUE
TRIAL LABOUR ?
THE METHODS OF
TERMINATION OF TRIAL IS BY
 SPONTANEOUS DELIVERY[30%].
 SYMPHYSIOTOMY FOLLOWED BY
FORCEPS OR VACCUM[30%].
 C-SECTION[30%]
 CRANIOTOMY [IF FETUS IS DEAD]

Cephalopelvic disproportion

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