Cephalopelvic Disproportion - Medical Malpractice Lawyers

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Cephalopelvic Disproportion - Medical Malpractice

Cephalopelvic disproportion occurs when the foetal head does not fit in the pelvic outlet or inlet of the maternal body so that the head cannot be born or cannot descend down the birth canal. It is one of the most common reasons for caesarean section. Cephalopelvic disproportion can cause prolonged labour, foetal distress and a delayed second stage of labour. The infant does not fit as planned in the maternal pelvis, even if it is descending in the pelvis in the normal way (not skewed or in the anterioposterior position). The mother simply pushes and pushes without adequate descent of the foetal head down through the pelvis. Labour can be completely stopped as a result so a caesarean section is required.

Doctors cannot always predict the presence of cephalopelvic disproportion. An ultrasound can define the size of the foetal head and this can perhaps indicate that cephalopelvic disproportion is going to happen but the medical standard is to have a trial of labour before giving up and going on to caesarean section. Sometimes, because the maternal pelvis is able to separate and stretch, the foetus can pass through the birth canal without difficulty even if the ultrasound indicated a large foetal head.

The causes of cephalopelvic disproportion are many. It can be due to an overall increase in size of the foetus. If the expected weight is ten pounds or more, you can expect foetal distress in such cases. If the maternal gestational age is greater than 42 weeks, you can expect that the foetus might not fit. Diabetic mothers are prone to cephalopelvic disproportion because they tend to have larger babies. Many women have babies of increasing size as they have more children and can eventually have cephalopelvic disproportion in later babies.

It makes a difference how the foetal head is descending into the pelvic canal. An occiput posterior position, in which the head of the baby is facing the sacrum, is at a higher risk of getting stuck. Slight rotations of the head or tilting of the head can make the presenting part of the baby too big so that the baby gets stuck going down the birth canal.

The shape and size of the pelvis can affect the presence of cephalopelvic disproportion. The pelvis can be small due to a small maternal frame and this can affect the passage of the foetal head. If there is osteomalacia of the pelvis, the shape of the pelvis is abnormal and the baby might not fit. A history of previous pelvic trauma, rickets or tuberculosis can mean the foetus won't fit into the birth canal. A history of tumours of the pelvic bone, a congenital deformity of the tailbone or a flattening of the anterior part of the pelvis, making for a triangular-shaped pelvis, can all lead to cephalopelvic disproportion.

Fibroid tumours of the uterus can affect the ability of the foetus to pass through the birth canal. Fibroids can block the pelvic passage and can result in cephalopelvic disproportion. If the cervix does not dilate properly, the head will not descend into the pelvis. If there is a congenital vaginal septum, the head may not fit into the pelvic space and there can be no vaginal delivery.

Sometimes doctors schedule a caesarean section when cephalopelvic disproportion is suspected but many go on to try a course of labour to see if the head does, in fact, pass through the birth canal. Sometimes it goes well and sometimes it does not. There can be foetal distress and an emergency caesarean section if the head does not descend properly. On the other hand, doctors cannot always predict how the foetal head is going to pass through the birth canal, making it difficult to know that a caesarean section is necessary. A trial of labour can go very well or can be disastrous, leading to foetal distress, foetal brain damage and an emergency caesarean section.

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The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here