Cephalo-pelvic disproportion

CPD

“DISPROPORTION IN SIZE BETWEEN THE FETAL HEAD AND THE MATERNAL PELVIC

Cause of CPD

Maternal :-
Contracted pelvis:-
Developmental:- android, anthropoid and platypelloid pelvis.
Congenital

FAULTY DEVELOPMENT:

PELVIC ANATOMY

PELVIC ANATOMY

PELVIC ANATOMY

CALDWELL-MOLOY CLASSIFICATION:
AFFECTED BY:
Evolutionary Influence
Hormonal Influence
Nutrition

PELVIC ANATOMY

CALDWELL-MOLOY CLASSIFICATION:
ANTHROPOID TYPE
GYNECOID TYPE
ANDROID TYPE
PLATYPELLOID TYPE

PELVIC ANATOMY

ANTHROPOID TYPE
GYNECOID TYPE

PELVIC ANATOMY

ANDROID TYPE

WIDE SUBPUBIC ANGLE IN GYNECOID TYPE NARROW IN ANDROID TYPE

DIAGNOSIS OF CONTRACTED PELVIS

Contraction may be at the level of brim,

DIAGNOSIS OF CONTRACTED PELVIS

PHYSICAL EXAMINATION:
HEIGHT: high risk <140 cm
SPINAL / CHEST

DIAGNOSIS OF CONTRACTED PELVIS

EXTERNAL PELVIMETRY:
Poor accuracy, no role in modern Obstetrics
1.

DIAGNOSIS OF CONTRACTED PELVIS

INTERNAL PELVIMETRY:
INSTRUMENTS vs VAGINAL EXAMINATION
VAGINAL ASSESSMENT OF PELVIC

CLINICAL PELVIMETRY

DORSAL LITHOTOMY POSITION
ASK TO EMPTY BLADDER
USE INDEX & MIDDLE FINGERS
SACRAL

VAGINAL ASSESSMENT OF PELVIS

CLINICAL PELVIMETRY

SACRAL CURVATURE
PELVIC SIDE WALLS
SACRO-SCIATIC NOTCH (Length of the sacro-tuberous Ligaments)
ISCHIAL

DIAGNOSIS OF CONTRACTED PELVIS

RADIOLOGICAL ESTIMATION:
1. X-RAY PELVIMETRY:
Pelvis- Lateral view, superio-inferior view,

MANAGEMENT OF LABOUR IN CONTRACTED PELVIS

HIGH RISK PREGNANCY-----REFERRED TO SPECIALISED CENTRE
MODE:
1.

MANAGEMENT OF LABOUR IN CONTRACTED PELVIS

ELECTIVE LSCS
INDICATIONS:
Gross CPD
Elderly Primi gravida
Toxemia of

MANAGEMENT OF LABOUR IN CONTRACTED PELVIS

ELECTIVE LSCS
TIMING:
Elective setting – planned procedure
Emergency

MANAGEMENT OF LABOUR IN CONTRACTED PELVIS

TRIAL LABOUR
INDICATIONS:
Mild / suspicion of CPD

TRIAL LABOUR

GOOD PROGNOSIS
Good Uterine contraction
Early engagement of Head
Rupture after full dilatation
Good