Cephalo pelvic disproportion obstetrics and gynaecological nursing

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2. Cephalo pelvic disproportion is the full form of CPD. Which is when the baby’s head is too large to fit through the mothers pelvis. When a baby is too large, it becomes challenging if not impossible for the baby to be delivered vaginally. Introduction

3. The disparity in the relation between the head and the pelvis is called cephalo pelvic disproportion. - D.C.Dutta (2019) Definition of CPD

4. Degrees of disproportion

5. No disproportion The head can be pushed down in the pelvis without overlapping of the parietal bone on the symphysis pubis. Moderate disproportion The head can be pushed down a little but there is slightly overlapping of the parietal bone evidenced by touch on the under surface of the fingers (overlapping by 0.5cm) Severe disproportion Head cannot be pushed down and instead the parietal bone overhangs the symphysis pubis the finger. Degrees of proportion

6. Cause of CPD

7. Rachitic pelvis

8. Diagnosis of Contracted Pelvis

9. Assessment of the pelvis can be done by bimanual examination : Clinical pelvimetry or by imaging studies, Radio- pelvimetry , Computed Tomography(CT) and MRI. Clinical pelvimetry : This is done manually Time In vertex presentation, the assessment is done at any time beyond 37 th week but better at the beginning of labour . Because of softening of the tissues, assessment can be done effectively during this time. Assessment of the pelvis

10. Procedures The patient is to empty the bladder The pelvic examination is done with the patient in dorsal position taking aseptic preparations. The following features are to be noted simultaneously: State of the cervix To note the station of the presenting part in relation to ischial spine. To test for cephalo pelvic disproportion in non engaged head. To note the resilence and elasticity of the perineal muscle. Assessment of the pelvis

11. The internal examination should be gentle, thorough, methodical and purposeful. It should be emphasized that the sterilised gloves fingers once taken out should not be reintroduced. Sacrum The sacrum is smooth, well curved and usually inaccessible beyond lower three pieces. The length, breath and its curvature from above down and side to side are to be noted. Sacro -sciatic notch The notch is sufficiency wide so that two fingers can be easily placed over the sacro-spinous ligament covering the notch. The configuration of the notch denotes the capacity of the posterior segment of the pelvis and the sidewalls of the lower pelvis. steps

12. Ischial spines Spines are usually smooth( everted ) and difficult to palpate. They may be prominent and encroached to the cavity thereby diminishing the available space in the mid pelvis. Ilio-pectineal lines To note for any breaking suggestive of narrow fore pelvis(android pelvis) Sidewalls Normally they are not easily palpable by the sweeping fingers unless convergent. Steps contd …

13. Posterior surface of the symphysis pubis It normally forms a smooth rounded curve. Presence of angulation or breaking suggests abnormality. Sacro-coccygeal joint Its mobilty and presence of hooked coccyx, if any are noted. Pubic arch Normally, the pubic arch is rounded and should accommodate the palmer aspect of two fingers. Configuration of the arch is more important than pubic angle. Pubic angle Fully abducted thumb and index fingers. It roughly corresponds to the family abducted middle and index fingers. Steps contd …

14. Transverse diameter of the outlet It is measured by placing the knuckles of the first interphalangeal joints or knuckles of clinched first between the ischial tuberosities . Anteroposterior diameter of the outlet The distance between the inferior margin of the symphysis pubis and the skin over the sacro-cocygeal joint can be measured either with the method employed for diagnonal conjugate or by external. Contd …

15. Classification of Disproportion

16. Abdominal method Abdominal vaginal (Muller-Munro Kerrr ) Imaging pelvimetry Cephalometry Ultrasound X-ray MRI Clinical methods

17. Abdomino -vaginal method( muller-munro kerr )

18. Abdomino -vaginal method( muller-munro kerr ) contd …

19. MINOR PROPORTION Minor degree of contracted pelvis – vaginal delivery MODERATE DISPROPORTION Trial labour If failed cesarean section MARKED DISPROPRTION Severe or extreme degree of contracted pelvis- cesarean section. Management od CPD

20. Lateral X-ray view with the patient in standing position is helpful in assess cephalo pelvic proportion. Cephalometry Accurate measurement of the bi parietal diameter would have been ideal to elicit its relation with the diameters of a planes of a given pelvis through which it has to pass. The average bi parietal diameter measures 9.4-9.8cm at term. MRI MRI is useful to assess the pelvic capacity at different planes. It equally informative to assess fetal size, fetal head volume and pelvic soft tissue which are also important for successful vaginal delivery. X-Ray pelvimetry

21. Minor degree- vaginal delivery Moderate degree- trial labour , if failed cesarean section. Marked disproportion- severe or extreme degree of contraction- cesarean section. management

22. FIRST STAGE Fetal distress Prolonged labour SECOND STAGE Delayed second stage Shoulder dystocia THIRD STAGE PPH Retained placenta Maternal injury Complication of CPD

23. Anatomical definition It is a pelvis in which one or more of its diameters is reduced below the normal by one or more centimeters.(0.5cm). Obstetrical definition It is a pelvis in which one or more of its diameters is reduced . So that it interferes with the normal mechanism of labour . D.C.Dutta Contracted pelvis-definition

24. Factors influencing the size and shape of the pelvis

25. Etiology of contracted pelvis

26. Diagnosis of contracted pelvis

27. In flat pelvis Antero posterior diameter of the pelvic brim is too short If mobilization of occiput means- biparietal diameter is the engaging diameter No mobilization of occiput means- brow or face presentation- bitemporal diameter is the engaging diameter.( super sup parietal diameter passess through the pelvic brim) Engagement occurs Follow all steps of mechanism Mechanism of labour in contracted pelvis

28. Cephalo pelvic disproportion is rare, but often diagnosed when a women’s labour fails to progress, the cervix has stopped dilating, or the baby does not descend through the pelvis. When an accurate diagnosis of CPD has been made, the safest type of delivery and reduce the mortality and morbidity rate amone maternal and newborn. conclusion

29. Write an assignment different types of pelvis, diagnosis and its management during labour Assignment

30. General System Theory THEORY APPLICATION INPUT The Students are having inadequate knowledge regarding CPD& Contracted pelvis THROUGHPUT The teachers teaching regardingCPD , Contracted pelvis degrees, diagnosis, management and complication,using powerpoint presentation. OUTPUT The students gain more knowledge about CPD, Contracted pelvis and diagnosis its management FEEDBACK 63

31. Ami, et al.,(2023) conducted retrospective study analysing the MRI result on childbirth stimulation to assess CPD and chances failed labour among 401 mothers were selected. The result showed 87(27%) of the mothers underwent CS, 314(78.3%) of the mothers had trial of labour , 183(45.6%) of the mothers experienced normal vaginal delivery. The result reviewed 5min MRI used to determine the pelvis size and actual need for a procedure. Journal application