Cephalopelvic Disproportion

Overview: 

Dystocia, or abnormally slow progress in labor, can result from cephalopelvic disproportion (CPD), malposition of the fetal head as it enters the birth canal, or ineffective uterine propulsive forces. Cephalopelvic disproportion occurs when there is mismatch between the size of the fetal head and size of the maternal pelvis, resulting in "failure to progress" in labor for mechanical reasons. Untreated, the consequence is obstructed labor that can endanger the lives of both mother and fetus 

1.Causes:

CPD: When a baby’s head or body is too large to fit through the mother's pelvis. It is believed to that true CPD is rare, but many cases of “failure to progress” during labor I given a diagnosis of CPD. The possible causes of CPD include: 

• Large baby due to: 

-Hereditary factors 

-Diabetes 

-Post maturity (still pregnant after due date has passed) 

-Multiparity (not the first pregnancy) 

• Abnormal fetal positions 

• Small pelvis 

• Abnormally shaped pelvis 

2. Complications 

• Premature rupture of membranes. 

• Dystocia. 

• Extreme molding of the head. 

• Umbilical cord prolapse. 

• Fetal distress. 

• Damage to the mom's perineum. 

• Injury to the baby's head. 

• Uterine rupture. 

3.Treatment: 

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 attempted. The use of oxytocin is often administered to see if this aids in labor progression or change in fetal positioning. 

When an accurate diagnosis of CPD has been made, the safest type of delivery for mother and baby is cesarean delivery. 

4.What RT related issues can come up with these patients?

• Emergency Cesarean Section (C-Section): If CPD is identified during labor and progresses to a point where vaginal delivery is not feasible, an emergency C-section may be necessary. A respiratory therapist needs to be prepared for a sudden change in the birthing plan and be ready to assist with any respiratory needs that may arise during or after the surgery. 

• Fetal Distress and Oxygenation: CPD can lead to prolonged labor, increasing the risk of fetal distress. Respiratory therapists may need to provide oxygen support to the mother if there are concerns about the baby's oxygenation during labor. 

• Neonatal Respiratory Support: Babies born to mothers with CPD may face respiratory challenges due to factors such as prematurity or the need for assisted ventilation during delivery. Respiratory therapists in the neonatal unit should be ready to provide specialized respiratory care to newborns in distress. 

• Monitoring for Respiratory Distress Syndrome (RDS): Babies delivered by C-section, especially in the case of CPD, may be at an increased risk of respiratory complications such as RDS. Respiratory therapists will play a crucial role in monitoring and managing respiratory issues in these infants. 

• Maternal Stress and Breathing Support: The stress of labor and delivery, particularly if complicated by CPD, can affect the mother's respiratory function. Respiratory therapists may need to provide breathing support or interventions to manage any respiratory distress the mother may experience. 

• Postpartum Care: In cases where CPD results in a C-section, the respiratory therapist may be involved in postpartum care, monitoring the mother for any respiratory issues that may arise during recovery.