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Cephalopelvic Disproportion (CPD)

Cephalopelvic disproportion, or CPD, is a “passenger-fit” disparity that can occur during the labor and delivery process. The baby is the “passenger” who has to “fit” through the mother’s pelvic bones. CPD occurs when the mother’s pelvic bones are unable to allow the baby to deliver through the vagina. This most often happens when the mother’s pelvis is shaped differently from the typical female pelvis, or gynecoid pelvis, which best accommodates delivery of a baby.  There are three other shapes of pelvises a woman can have that may make delivery of a baby very difficult, if not impossible. CPD is also likely when the baby is large, the baby’s head is turned a certain way, or a combination of the two.

Practitioners must assess CPD during the labor process. This is done by determining if the baby is facing up or down, whether its chin is tucked down on its chest, the amount of descent through the pelvis and the way the bones in the baby’s head are accommodating the mother’s pelvis.  These measurements are done during a sterile vaginal exam.  CPD can be difficult to diagnose before labor starts, but risk factors such as having had CPD in the past, the size of the mother’s pelvis, a baby who is not in the normal position for delivery, and short maternal height can be assessed prenatally.

CPD can cause prolonged labor, especially in the second stage, for which the baby may not be able to tolerate. A prolonged second stage of labor is associated with decreased oxygen delivery to the baby, seizures after birth, and risk for cerebral palsy. A difficult delivery due to a “passenger-fit” mismatch between the baby and the mother’s pelvis can result in brain hemorrhaging, brachial plexus injury, clavicle or skull fractures, the baby getting “stuck” in the maternal pelvis, and compressed or prolapsed umbilical cords. All these risk factors can contribute to lifelong injury.

Cesarean section is often recommended if the baby is not moving down in the pelvis and exhibits abnormal heart rate patterns. It is important to note that the use of vacuum or forceps when CPD is suspected is not advised.

If your baby suffered an injury during the birthing process, please contact us at 877-262-9767.

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