Client Initials:

Medical Diagnosis: Cephalopelvic Disproportion

Name:
Date:

DEFINITION:
The relationship between the measurements of the fetal head and the diameters
of the maternal pelvis.

RELATED DIAGNOSTIC TESTS:

Ultrasound of fetus to determine presentation and lie.
Manual exam before labor
CT scan with estimated weight of fetus.

ETIOLOGY:

The birth passage includes the maternal bony pelvis, beginning at the
pelvic inlet and ending at the pelvic outlet. A narrowed diameter in these
areas can result in CPD if the fetus is larger than the pelvic diameters.

MEDICAL MANAGEMENT:
The adequacy of the maternal pelvis for a vaginal birth should be assessed both
during and before labor. During the intrapartal assessment, the size of the fetus
and its presentation, position, and lie must also be considered.
Frequent assessments of cervical dilation and fetal descent are made.
If progress ceases, the decision for a cesarean birth is made.

PATHOPHYSIOLOGY:
Labor is prolonged in the presence of CPD. Membrane rupture can result from
the force of the unequally distributed contractions being exerted on the fetal
membranes.
In obstructed labor, in which the fetus cannot descend, uterine rupture can
occur. With delayed descent, necrosis of maternal soft tissues can result form
pressure exerted by the fetal head. Eventually, necrosis can cause fistulas from
the vagina to other nearby structures. Difficult, forceps-assisted births can also
result in damage to maternal soft tissue.

NURSING MANAGEMENT:
Vitals q4hrs or as ordered by doctor.
Monitor both contractions and fetus continuously.
Any signs of fetal distress are reported to the CNM or MD immediately
Position mother in ways to increase the pelvic diameters.
Sitting or squatting increases the outlet diameters and may aid in fetal descent.
Monitor fetus for signs of hypoxia take appropriate actions if necessary.
Monitor mother and fetus for any signs of distress.
Monitor contractions and EFM or IFM, report any unusual findings.

SIGNS & SYMPTOMS:

HEALTH DEVIATION SELF-CARE REQUISITES:

Encourage pt to assume a position that will add in the descent of fetus.
Provide support to client and family members in coping with the stress of a
complicated labor.
Encourage pt to drink clear fluids to maintain hydration.
Encourage pt to take cleansing breaths in-between contractions to promote
adequate oxygen exchange for her and baby.

*Prolonged labor
*Cervical dilation and effacement are slow
*Engagement of the presenting part is delayed
*Adequacy of the maternal pelvis small for size of fetus

REFERENCE PAGES:
Contemporary Maternal-Newborn Nursing Care, Ladewig, London, Moberly,
Olds
Pgs 488, 489
Tabors Medical Dictionary, Davis, pg 37