Cephalopelvic Disproportion (CPD) Signs and Symptoms

Cephalopelvic Disproportion (CPD) is a potentially serious complication that occurs during childbirth in which the baby's head or body is too large to fit through the mother's pelvis, often necessitating surgical intervention and other management. Recognizing the symptoms and promptly addressing signs of CPD is extremely important, as the impact to both the mother’s and baby’s health can be catastrophic, even jeopardizing a safe delivery. Common signs of a CPD pregnancy include a large amount of amniotic fluid, fetal distress, prolonged labor, and an abnormally large distance between the top of the uterus and the mother’s pubic bone. 

Cephalopelvic disproportion is rare. In a population-based study of more than 240,000 births, CPD was diagnosed in about 0.3% of deliveries, or roughly 1 in 300. But when the condition goes unrecognized, it can quickly become dangerous for both the mother and the baby.

When medical negligence such as a failure to diagnose or properly manage CPD leads to birth injuries or childbirth trauma, those affected may be entitled to compensation for the undue medical expenses, emotional anguish, and pain and suffering they endure as a result. A knowledgeable medical malpractice lawyer can help families explore their options. 

What is Cephalopelvic Disproportion (CPD)

Cephalopelvic Disproportion, or CPD (sometimes called fetopelvic disproportion), is a medical term meaning that a baby's head or body is too large to pass through the mother's pelvis during childbirth. A rare complication, CPD is generally a result of the size or positioning of the fetus, the shape or size of the mother’s pelvis, or some combination of both. CPD can lead to difficulties during labor, making it challenging or sometimes impossible for the baby to be delivered vaginally. 

The significance of CPD in pregnancy and childbirth lies in its potential to cause serious complications if not properly diagnosed and managed. When a doctor, nurse, or other medical professional identifies CPD early enough in the labor process, there’s typically plenty of time to review the safest options for delivery with the parents and avoid further issue. But gone unrecognized, CPD can prolong labor and cause fetal distress, potentially leading to birth injuries and other lasting harm.

What are the Risk Factors and Causes of CPD?

CPD in pregnancy is rarely diagnosed prior to labor; however, presence of certain genetic, medical, and/or lifestyle risk factors earlier in pregnancy can increase the likelihood of a complication like CPD. 

Genetic factors involve inherited characteristics that may affect the physical size and shape of both the baby and the mother:

• Pelvic abnormalities including a flat (platypelloid) or narrow opening or heart-shaped (android) pelvis
• Family history of large babies (macrosomia) or of CPD itself
• Genetic conditions affecting bone development and structure
• Petite size of mother

Medical factors concern conditions or circumstances that develop during pregnancy or exist chronically which could affect the size or positioning of the baby or pelvis:

• Gestational diabetes leading to fetal macrosomia
• Multiparity, or having had multiple pregnancies (in certain cases, baby size may increase with each subsequent pregnancy)
• Abnormal fetal position such as breech or transverse lie
• Pelvic malformations causing bony growths or bones out of place
• Previous pelvic injury or fracture
• Post-term (42+ weeks) pregnancy
• Previous history with CPD or difficult deliveries

Lifestyle factors can also play a role in development of CPD:

• Lack of proper prenatal care, leading to unmonitored fetal growth and development
• Poor maternal nutrition and/or sedentary lifestyle
• Birthing in adolescence, before pelvis is skeletally mature

These factors may be indications of risk for CPD in pregnancy and labor. However,  sometimes the condition can develop even in the absence of classic risk factors. Responsible OB/GYNs and other medical caregivers present during childbirth monitor the baby and mother throughout labor and recognize warning signs as they emerge.

What are the Signs and Symptoms of CPD? 

CPD is considered mainly a childbirth condition because most symptoms and signs arise early in labor. Additionally, that is when intervention is likely to occur (even if risk has already been established). It is critical for medical caregivers to act quickly if they notice signs that the baby is too big for the mother's pelvis in order to prevent further complications. 

Consider some of the most common indicators that could point to cephalopelvic disproportion:

• Prolonged labor: Also known as failure to progress, prolonged labor is characterized by labor that lasts 20 or more hours for a first-time labor, or 14 or more hours for subsequent labors, after regular contractions begin.
• Fetal distress: Symptoms of fetal distress, including rapid or slowing heart rate, meconium (residue from an infant’s bowel movement) in the amniotic fluid, and/or changes in movement or position can indicate CPD when a pregnancy lasts too long or if labor is difficult.
• High levels of amniotic fluid: Medically known as polyhydramnios, too much amniotic fluid causes the uterus to become larger than average.
• Large fundal height measurement: The distance from the pubic bone to the top of the uterus is called the fundal height. Typically, the fundal height should correlate with the weeks of gestation. When a fetus measures large for their gestational age based on due date, it can mean that fundal height is more than 3 centimeters larger than anticipated at a given stage of pregnancy, indicating macrosomia, a medical term for an infant that is larger than average in size – typically around 9 pounds or more. 

How Is CPD Diagnosed? (Common Tests for CPD)

CPD is rarely diagnosed before labor begins. When a provider suspects it, however, several methods can help confirm or rule it out. These include a physical pelvic exam, an ultrasound to measure the size of the baby and the pelvic opening, and in some cases an X-ray, CT scan, or MRI of the pelvis.

Because these measurements are not always precise, ongoing monitoring throughout labor is often just as important as any single test. When a provider fails to order appropriate testing or misreads the results, and that failure leads to injury, it may support a claim of medical negligence.

Treatment and Management of CPD

Once CPD is suspected or confirmed, the obstetrician should discuss the safest path to delivery with their patient. Options generally fall into three categories:

• Medical intervention: A doctor may order oxytocin if an accurate CPD diagnosis cannot be made, but labor has stalled. Oxytocin is a drug used to induce labor and help it progress; however, in the case of a clear CPD diagnosis Pitocin or oxytocin should not be used and could lead to complications.
• Delivery techniques: If the baby appears stuck in the birth canal, the doctor may attempt assisted delivery methods, including a forceps delivery or vacuum extraction, to help reposition the baby and guide it through the birth canal. Sometimes these instruments can enable successful vaginal delivery even with CPD. In other instances, repeated attempts at assisted delivery techniques during a CPD birth can cause unnecessary injuries to the parent or child. 
• Surgical options: Once a CPD diagnosis is confirmed, the obstetrician may recommend a cesarean section (surgical delivery) after considering all factors, including safety of the baby. Sometimes they may call for an emergency C-section after attempting non-surgical methods unsuccessfully.

In a CPD birth, responsible medical professionals use their expertise to help their patients deliver safely. Failing to recognize the need for surgical intervention could lead to birth injury from CPD and even constitute medical negligence.

What Legal Options Are Available for Your Family After a CPD Birth Injury?

Cephalopelvic disproportion does not generally pose a serious risk to the baby or mother when detected and addressed properly. But an undiagnosed case of CPD could have horrifying consequences including birth injuries to the infant from unsuccessful forceps use or from lack of oxygen to the brain and post-partum complications involving the mother. 

In the event that an injury occurred after an obstetrician or other medical caregiver overlooked or failed to notice signs of CPD and take necessary action, it may be time to explore the legal options available. In a medical malpractice claim, families affected by a healthcare professional’s negligent action or inaction can seek compensation for the losses they suffer including medical expenses, future care costs, lost wages, and emotional pain and suffering. 

The legal process begins with consulting a CPD birth injury lawyer who can evaluate the case and its details, determining if negligence played a role and who is liable. Once filed, the cephalopelvic disproportion injury lawsuit goes through rounds of evidence accumulation and negotiation with the parties involved, typically culminating in a settlement or occasionally proceeding to trial.

Pursuing compensation through legal channels can significantly alleviate the financial burden of a birth injury, covering both immediate and long-term needs. Make sure to secure representation from an experienced attorney in order to obtain the highest settlement possible. 

When an attorney reviews a potential CPD birth injury case, they are looking for evidence of four elements:

• A doctor-patient relationship and duty of care existed
• Your provider deviated from the accepted standard of care and breached that duty
• That breach caused you or your baby harm
• The injury resulted in compensable damages

The Beasley Firm can Help with CPD Birth Injury Lawsuits

The injury attorneys of The Beasley Firm in Philadelphia have extensive experience litigating highly complex CPD labor and delivery negligence cases. In fact, our legal team, which includes two doctors with extensive knowledge of maternal and neonatal care, has recovered hundreds of millions of dollars in rightful compensation for victims of medical malpractice, helping to secure their future medical care and financial stability while holding negligent parties accountable.

Work with our nationally-recognized legal practice to pursue the just compensation you’re entitled to. Call The Beasley Firm at (215) 866-2424 or contact us online for a free case evaluation.

Frequently Asked Questions

What causes CPD in pregnancy?

Cephalopelvic disproportion (CPD) is the medical term used to describe when an infant’s head or body is too large or improperly positioned for delivery. Causes include having an unusually large baby due to hereditary, medical or lifestyle factors, having a small or abnormally shaped pelvis, and/or the baby being in breech or transverse lie (sideways) position.

How is CPD diagnosed? What happens if CPD is not diagnosed?

CPD is typically diagnosed during the early stages of labor. One sign is a failure for the labor to progress. A doctor or other birth attendant can diagnose CPD if they notice signs or symptoms by assessing the baby’s position, checking the cervix, and using a fetal monitor to follow contractions. When CPD goes unrecognized, labor can stall while the baby is subjected to increasing stress, raising the risk of oxygen deprivation and serious birth injuries. Delayed recognition of CPD is often central to birth injury malpractice claims.

What are the signs that a baby is too big for the pelvis?

Signs that the baby is too big for the pelvis include prolonged laboring, indications of fetal distress, and high levels of amniotic fluid.

What treatment options are available for CPD?

Because CPD can cause fetal distress, generally, the safest form of delivery is a cesarean section. In certain cases, assisted delivery techniques, such as using tools like forceps or a vacuum extractor, may also be successful when CPD is present.

Can CPD lead to birth injuries?

Common birth injuries associated with undiagnosed CPD can include shoulder dystocia, cerebral palsy, umbilical cord prolapse, and hypoxic-ischemic encephalopathy (HIE). Left untreated, mothers with CPD may also be at an increased risk of postpartum hemorrhage, uterine rupture, or perineal damage.

Is CPD considered medical malpractice? Can you file a birth injury claim for CPD?

If a CPD-related birth injury resulted from negligence, pursuing a medical malpractice claim may be the best legal option available. In a successful lawsuit, families affected can recover compensation for the immediate and long-term costs of medical care, lost wages due to missed work, and emotional anguish suffered.