Signs and Symptoms of Cephalopelvic Disproportion

Common signs of cephalopelvic disproportion 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. 

What is Cephalopelvic Disproportion?

Cephalopelvic disproportion is a rare type of injury that can happen during childbirth. This happens when the baby's head is too big to fit through the mother's pelvis, especially if the baby is large or in an unusual position. The shape of the mother's pelvis can also play a role.

Whether it’s your first birth experience or your third, being a little nervous about your pending delivery is to be expected. The good news is, most deliveries happen without incident. However, in other cases, some risks could lead to complications such as cephalopelvic disproportion (CPD).

CPD can occur when there is a disproportion between a fetus’ size and the mother’s pelvis. Here’s what you need to know about the risk factors and warning signs associated with this birth complication.

The Risk Factors

While CPD is rare, some risk factors can increase the chances of CPD:

• Gestational DiabetesGestational diabetes can cause fetal macrosomia — a condition in which a fetus weighs more than 8 lbs, 13 ounces (4,000 grams), no matter what their gestational stage. A large baby, even if not macrosomic but large relative to the pelvic proportions, can have challenges passing through the birth canal.
• Narrow PelvisIn some cases, the mother may have a pelvis that is too narrow or abnormally shaped to deliver the baby vaginally. Before giving birth, your obstetrics provider should ensure that the examinations also include an evaluation of the pelvic outlet to determine if you may be at risk of CPD.
• Post-Term Fetus
  • A pregnancy is generally considered to last 40 weeks. A “term” pregnancy is defined by the American College of Obstetrics and Gynecology (ACOG) as follows:
  • Early term – (37 0/7 weeks of gestation through 38 6/7 weeks of gestation)
  • Full term – (39 0/7 weeks of gestation through 40 6/7 weeks of gestation)
  • Late term – (41 0/7 weeks of gestation through 41 6/7 weeks of gestation).

ACOG defines “post-term” as 42 0/7 weeks of gestation and beyond

Obviously, as the gestation progresses, the fetus continues to grow. So, the longer the gestation, the larger the fetus, and the risk for complications from CPD increases.

The Warning Signs

Some indicators that could point to cephalopelvic disproportion in pregnancy are:

• Prolonged labor - Also known as failure to progress, prolonged labor is characterized by labor that lasts 18 to 24 hours after regular contractions begin.
• Fetal distress - Symptoms of fetal distress can happen when a pregnancy lasts too long, or 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 your pubic bone to the top of your uterus is called the fundal height. Typically, the fundal height (in centimeters) should correlate with the weeks of gestation. When a fetus measures large for their gestational age (based on your due date), it means that your fundal height is more than 3 centimeters larger than anticipated at your stage of pregnancy.

CPD may also be a catalyst to many types of birth injuries and complications, including but not limited to:

• Cerebral palsy
• Hypoxic brain damage
• Shoulder dystocia

Is Normal Delivery Possible with CPD?

According to the American College of Nurse-Midwives (ACNM), cephalopelvic disproportion is rare but still occurs in as many as 1 out of every 250 pregnancies. Because CPD can cause fetal distress, generally, the safest form of delivery is a cesarean. CPD can be diagnosed throughout the pregnancy, but many times it is not identified until labor and delivery.

A c-section can help prevent prolonged labor and avoid fetal distress. Common complications associated with CPD can include shoulder dystocia, cerebral palsy, umbilical cord prolapse, and hypoxic-ischemic encephalopathy (HIE). Left untreated, CPD may also be at an increased risk of postpartum hemorrhage, uterine rupture, or damage to the mother’s perineum.

Studies show that women who were diagnosed with CPD in previous pregnancies have been able to deliver subsequent children vaginally without issue.

How and When is CPD Diagnosed?

CPD warning signs may exist throughout a woman’s pregnancy, but the condition often remains undiagnosed until the labor and delivery process. Unfortunately, a diagnosis may not be made until there is a problem, such as when labor fails to progress. 

An accurate, prompt diagnosis of CPD can ensure the safe delivery of the baby and prevent dangerous complications. Early signs of cephalopelvic disproportion may include gestational diabetes, abnormal fetal positions, and an abnormally shaped or narrow pelvis. 

During delivery, it is critical that your healthcare provider closely monitor your contractions and dilation to make sure that labor is progressing normally. In addition, your baby’s movements and heart rate should be reviewed regularly for signs of distress. A delayed diagnosis of the condition increases the risk of complications. Diligent fetal monitoring can help ensure that a diagnosis is made as early as possible.

How Do You Treat CPD?

Once a diagnosis of CPD is made, a doctor will likely order delivery via cesarean section. By ordering an emergency c-section, the doctor can prevent serious complications related to prolonged labor and fetal distress. 

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. If the baby appears stuck in the birth canal, an obstetrician may use assisted delivery methods, including a forceps delivery or vacuum extraction, to help reposition the baby. 

A failure to order an emergency cesarean when there are signs of cephalopelvic disproportion can result in harm to both mother and child. If you or your child suffered an injury due to a doctor’s failure to diagnose and treat CPD, it is strongly recommended that you consult with an attorney.

Did Your Child Suffer a Birth Injury? We can help

If your physician failed to treat you or your baby properly during labor and delivery, you have the right to seek justice and compensation. At The Beasley Firm, LLC, our birth injury attorneys have extensive experience in litigating highly complex birth injury cases. We’ve recovered hundreds of millions of dollars for our clients to secure their future care, education, and comfort needs.

We are here to help you through this difficult time. Contact The Beasley Firm, LLC to schedule a free consultation.