7/21/2019 Cephalopelvic Disproportion and External Cephalic Version

http://slidepdf.com/reader/full/cephalopelvic-disproportion-and-external-cephalic-version 1/6

Group 2:

Topics:

Problems with the passage:

Cephalopelvic Disproportion (CPD)

External Cephalic Version

embers:

Aragon, !ohn Ce"ric

Decena. #imberl$ !o % &nn

Francia' Diana arie

Jainal' Elham

Nobi, &nita

Noritomi, rene

Tuazon, Carina sabela

Cephalopelvic Disproportion (CPD)• Implies disproportion between the head of the baby ('cephalus') and the mother's pelvis.

• Complications can occur if the fetal head is too large to pass thorugh the mother's pelvis or birth canal. This can be

because of a small pelvis and an average sized fetus, a large baby with an average sized pelvis or because of

malposition of teh fetal head.

7/21/2019 Cephalopelvic Disproportion and External Cephalic Version

http://slidepdf.com/reader/full/cephalopelvic-disproportion-and-external-cephalic-version 2/6

• C! is one of the commonest cause of different complications in labor, including prolonged labor, fetal distress, and

delayed second stage.

Cephalo-pelvic disproportion (CPD)

• Is very fre"uently diagnosed and is a very common indication of cesarian sections, especially when there is failure to

progress in labor.

• #ut it is very difficult to diagnose C! before a women has started her labor pains since it is very difficult to anticipate

how well the fetal head and the maternal pelvis will ad$ust and mould to each other.

Causes of Cephalopelvic Disproportion (CPD):

 

Increased Fetal Weight:

%ery large baby due to hereditary reasons & a baby whose weight is estimated to be above gs or *

pounds . ostmature baby & when the pregnancy goes above + wee-s.

#abies of women with diabetes usually tend to be big. #abies of mothers who have had a number of children & each succeeding baby tends to be larger and heavie

 

Abnormal Fetal Position:

ccipito&posterior position & In this position the fetus faces the mothers abdomen instead of her bac-.

#row presentation

/ace presentation.

  Problems ith the Pelvis:

0mall pelvis.

 1bnormal shape of the pelvis due todiseases li-e ric-ets, osteomalacia ortuberculosis.

 1bnormal shape due to previous accidents.

Tumors of the bones.

Childhood poliomyelitis affecting the sha

of the hips. Congenital dislocation of the hips.

Congenital deformity of the sacrum or

coccy

 

Problems ith the !enital tract:

Tumors li-e fibroids obstructing the birth

passage. Congenital rigidity of the cervi2.

0carring of the cervi2 due to previous

operations li-e conisation. Congenital vaginal septum

7/21/2019 Cephalopelvic Disproportion and External Cephalic Version

http://slidepdf.com/reader/full/cephalopelvic-disproportion-and-external-cephalic-version 3/6

  "o is cephalopelvic disproportion (CPD) diagnosed#

• The diagnosis of cephalopelvic disproportion is often used when labor progress is not sufficient and

medical therapy such as use of o2ytocin is not successful or not attempted. C! can rarely be diagnosed

before labor begins if the baby is thought to be large or the mother3s pelvis is -nown to be small.

• !uring labor, the baby3s head molds and the pelvis $oints spread, creating more room for the baby to pass

through the pelvis.

•  $ltrasound is used in estimating fetal size but not totally reliable for determining fetal weight. 1 physical

e2aminati on that measures pelvic size can often be the most accurate method for diagnosing C!. If atrue diagnosis of C! cannot be made, o2ytocin is often administered to help labor progression.

 1lternat ive ly, the fetal position is changed.

  %his results in failure to progress in labor& 

Inlet Contraction

• 4arrowing of 1 (anteroposterior) diameter to less than cm or 

• Transverse diameter to cm or less

• 5ngagement will not occur 

• 6easure pelvis before + wee-s of pregnancy

• C!&floating&malposition&76&cord prolapse

  'utlet Contraction

• 4arrowing of the transverse diameter at the outlet to less than cm. This is the distance between the ischial

tuberosities, a measurement that is easy to ma-e during prenatal visit, so the narrow diameter can be anticipated

before labor begins

  %rial abor 

• is the conduction of spontaneous labour in a moderate degree of  cephalopelvic disproportion.

• If a woman has a borderline inlet measurement and the fetal lie and position are good, her physician or nurse midwife

may allow her a 8trial labor9 to determine whether a labor can progress normally.

•  1 trial labor continues as long as descent of the presenting part and dilatation of the cervi2 are occuring.

  A*A!++*%

• 6onitor uterine contraction and monitor fetal heart sound continuously.

• :rge the woman to void every hrs& to empty the bladder to allow the fetal head to use all space available.

•  1fter rupture of the membranes, assess /;7 carefully ( if the fetal head is still high, there is an increased danger of

prolapsed of the cord or fetal ano2ia.

%reatment of Cephalopelvic Disproportion (CPD):

  Then a Caesarean section is the only option

7/21/2019 Cephalopelvic Disproportion and External Cephalic Version

http://slidepdf.com/reader/full/cephalopelvic-disproportion-and-external-cephalic-version 4/6

  External Cephalic Version

• 52ternal cephalic version, or version, is a procedure used to turn a fetus from abreech position or side&lying

(transverse) position into a head&down (verte2) position before labor begins. <hen successful, version ma-es it

possible for you to try a vaginal birth.

• It may be done as early as =+ to = wee-s, although the usual time is => to =? w-s of pregnancy.

• %ersion is done most often before labor begins, typically around => wee-s. %ersion is sometimes used during labor

before the amniotic sac has ruptured.

•  1 scheduled cesarean is used to deliver most breech births if a version doesn't wor-.

7/21/2019 Cephalopelvic Disproportion and External Cephalic Version

http://slidepdf.com/reader/full/cephalopelvic-disproportion-and-external-cephalic-version 5/6

  What to do:

 

,ersion procedure

#efore the version attempt, you may be given an in$ection of  tocolytic medicine to rela2 the uterus and preve

uterine contractions. The most commonly used tocolytic medicine is terbutaline. <hile the uterus is rela2ed, your doctor will attempt to turn the fetus. <ith both hands on the surface of

your abdomen one by the fetus's head and the other by the buttoc-s. The doctor pushes and rolls the fetus to a head&down position.

@ou will feel discomfort during a version procedure, especially if it causes the uterus to contract. The amount

discomfort depends on how sensitive your abdomen is and how hard the doctor presses on your abdomen

during the version attempt. If your fetus appears to be in distress, as shown by a sudden drop in heart rate, t

procedure is stopped.

If a first attempt at version is not successful in turning the fetus, your doctor may suggest another attempt,possibly with epidural anesthesia to help you rela2 and to reduce pain associated with the

procedure. +pidural anesthesia may increase the success of repeated version attempts. 0erious complications are rare during e2ternal cephalic version. #ut they do happen. This is why a version is

performed in a hospital where you can have an emergency C&section delivery if needed.

  Fetal monitoring is used

To avoid harm to the fetus, a version procedure is closely monitored.

/etal ultrasound is first used to confirm the fetus's position, where the placentais, and the amount of amniotic

fluid. /etal ultrasound is often used to watch the fetal position during the version attempt. 5lectronic fetal heart monitoring is used before, possibly during, and after a version attempt. 1n

active fetus whose heart rate increases normally with movement is usually considered to be healthy. If thefetus's heart rate becomes abnormal, the version procedure may be stopped.

  anagement :

• !uring the procedure, /;7 and possibly ultrasound are recorded continuously.

• Tocolytic agent may be given.

• The breech and verte2 position of the fetus are located and grasped transabdominally by the e2aminer3s hands on th

woman3s abdomen.

• Aentle pressure is then e2erted to rotate the fetus in a forward direction to a cephalic lie.

  Contraindication:

7/21/2019 Cephalopelvic Disproportion and External Cephalic Version

http://slidepdf.com/reader/full/cephalopelvic-disproportion-and-external-cephalic-version 6/6

• The bag of waters (amniotic sac) has ruptured.

• The mother has a condition (such as a heart problem) that prevents her from receiving certain tocolytic

medicines to prevent uterine contractions.• 6ultiple Aestation

• 0evere ligohydramnios

• Cord coil

• :ne2plained third trimester bleeding

• 52ternal Cephalic %ersion

• The mother's uterus does not have a normal shape.