1. Warm Greetings
PESIMSR , Kuppam

2. Cepahalopelvic disproportion- FAQs
Dr.B.S.Bhat
Professor and Head
Department of Obstetrics and Gynaecology
PES-IMSR,Kuppam

3. Q)Causes of mobile head in a nullipara at term A) 1)Occipitoposterior position 2)CPD 3)Malpresentation 4)Tumours in the lower segment 5)Placenta previa 6)Cord around the neck 7)Tumours of the fetal neck 8)Polyhydrominos 9)Hydrocephalus 10)Distended bladder and rectum

4. Q)Definition of contracted pelvis -Anatomical definition -Obstetric definition A) -Alteration in the size and/or shape of the pelvis of sufficient degree so as to alter the normal mechanism of labour (Obstetrical definition) - Pelvis in which any essential diameter of the pelvis is shortened by greater than 0.5 cms (Anatomical definition) [Holland and Brews]

5. Q)Inlet Contraction A)
Anteroposterior diameter < 10 cms or
Transverse diameter < 12 cms

6. Q)Midpelvic Contraction
Interspinous diameter < 9 cms
Interspinous diameter + Posterior Sagittal diameter < 13.5 cms
X- Ray pelvimetry essential

7. Q)Outlet Contraction A)
Distance between ischial tuberosities< 8 cms
Intertuberous diameter + Posterior sagittal diameter < 15 cms

8. Q) Definition of CPD A) Disparity in the relation between the head and the pelvis

9. Q)Types of pelvis A)4 types -Gynaeoid:50% -Antropoid:25% -Android:20% -Platypelloid:05%

10. -Naegele’s pelvis: Lack of development of one sacral ala -Robert’s pelvis: Lack of development of both sacral alae -Rachitic pelvis: Reniform inlet -Osteomalacic pelvis: Triradiate inlet -Split pelvis: Gap between the pelvic bones -High assimilation pelvis: 6 sacral vertebrae -Low assimilation pelvis: 4 sacral vertebrae

11. Q)Common causes of contracted pelvis A) -Nutritional and Environmental defects -Diseases or injuries of the pelvis -Developmental defects

12. Q)Mechanism of labour in Flat pelvis A) -BPD is placed in Sacro-cotyloid diameter and Bi-temporal diameter is in the narrow conjugate (Lateral mobilisation). -Exaggerated parietal presentation- Supersub parietal diameter passes through the brim. -Extreme moulding

13. Q)Short Stature A) Less than 140 cms

14. Q) Clinical Pelvimetry A) At the beginning of labour

15. Clinical pelvimetry Inlet Cavity Outlet Sacral promontory
Diagonal conjugate
Sacral curvature
Pelvic side walls
Ischial spines
Sacrosciatic notch
Subpubic angle
Subpubic arch
Transverse diameter

16. Assessment of Pelvic inlet

17. Assessment of Pelvic inlet

18. Assessment of Pelvic cavity

19. Assessment of Pelvic cavity

20. Assessment of Pelvic outlet

21. Assessment of Pelvic outlet

22. Munro Kerr Muller method

23. Diagnosis of CPD Munro Kerr Muller method No Disproportion
Mild Disproportion
Major Disproportion

24. Diagnosis of CPD Chassar Moir’s method: Abdominal method
Procedure: Index and middle finger of the right hand are placed over pubic symphysis, with the ulnar border of left hand fetal head is pressed in downwards and backward direction in the axis of pelvic inlet

25. Diagnosis of CPD Chassar Moir’s method:
Inference: Only brim disproportion can be excluded
If the head can be pushed in the pelvis without overlapping of bones-No Disproportion
If the parietal bones flush with the anterior surface of the symphysis pubis-Minor degree Disproportion
If the parietal bone overhangs symphysis pubis-Major degree Disproportion

26. Diagnosis of CPD Ian Donald method Abdominal method
Using 3,4,5th fingers of both
hands, head is gripped at
sinciput and occiput
One of the index fingers usually the left reaches over and identifies position of the top of symphysis pubis
The thumbs are pressed backwards against the parietal eminence

27. Diagnosis of CPD Ian Donald method
An assisstant applies his hands to baby’s breech and presses the whole child towards the pelvis
At the same time thumbs applied to the parietal eminences press downwards and backwards while the fingers on siniciput and occiput can observe what is happening and the index finger of the left hand is kept as before at the upper margin of pubic symphysis

28. Diagnosis of CPD Ian Donald method Inference
If head can be pushed down into the pelvis without overlapping of parietal bone on pubic symphysis -Disproportion is ruled out
If head pushed down a little, slight overlapping of parietal bone evidenced by touch on undersurface of fingers-Minor degree CPD is suspected

29. Diagnosis of CPD Ian Donald method Inference
If head cannot be pushed down and instead parietal bone overhangs the symphysis pubis, displacing the fingers-Major degree CPD is suspected

30. Diagnosis of CPD Hillis Muller test Bimanual method
When contractions is at its peak, an attempt is made to push the presenting part into the pelvis by pressing on the uterine fundus with free hand.
The hand in the vagina is used to determine whether or not there is downward mobility of presenting part.

31. Diagnosis of CPD Hillis Muller test Inference
If the presenting part does not move or moves very little, the possibility of CPD is high
If the presenting part moves easily into the pelvis, possibility of disproportion is low

32. Diagnosis of CPD Purandhare’s method:
Abdominal method (exaggerated lithotomy
position)
Procedure: Fetal head grasped by the left hand.
2 fingers of the right hand are placed above pubic symphysis. The fetal head is tried to push down into the pelvis.

33. Diagnosis of CPD Purandhare’s method: Inference
Head enters superior strait-No CPD at brim
Head flush with pubic symphysis-Minor
degree CPD
Head overrides pubic symphysis- Major

34. Q)Pointers towards CPD in labour A) -Prolonged labour despite augmentation with Oxytocin -Head remaining high at full dilatation -Cervix loosely applied to the head -Excessive caput or irreducible moulding of the fetal head

35. Q)Trial of Labour A) - It is the conduction of labour in a minor degree CPD ,in an institution under supervision with watchful expectancy, hoping for a vaginal delivery.

36. Q)Factors responsible for successful trial
Force – Efficient uterine contraction
Passage – “Give way “ of the pelvis
Passenger – Moulding of fetal head

37. Q)Contraindications for trial of labour
Severely contracted pelvis
Maternal or fetal complications
Medical disorders
Previous failed trial of labour
Previous stillbirth or spastic child

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