User:Mr. Ibrahem/Cephalopelvic disproportion

Cephalopelvic disproportion (CPD) occurs when the size of the mothers pelvis, and thus birth canal, is smaller than the size of the babies head. Symptoms include difficult childbirth, specifically a form known as obstructed labor. Complications may include death of the baby, cerebral palsy, brachial plexus injury, obstetrical fistula, and pelvic floor dysfunction.

The most common cause is a small pelvis. Other causes include an overly large baby, which may occur due to hydrocephalus, thyroid tumors, or macrosomia. Some also include relative size difficulties such as occur in malpresentation of the babies head. Risk factors include being short (<1.60 m), rickets, and prior pelvic fracture. Diagnosis is based on symptoms such as failure of the head to decend into the pelvis and the shape of the babies head changing; though may be supported by medical imaging.

Treatment often requires C-section; however, occasionally an operative vaginal delivery or oxytocin infusion maybe used. Oxytocin is associated with a risk of uterine rupture. Preventive efforts may include induction of labor at 38 weeks in those with large babies.

Cephalopelvic disproportion occurs in about 1 in 250 pregnancies. Poor outcomes are particularly common in low and middle income countries where access to expert care is often limited. In high income countries some women are refusing typically recommended management options. It is a relatively common reason for legal cases in obstetrics.