✔️The term “cephalopelvic disproportion” (CPD) has been used to describe a disparity between the size of the maternal pelvis and the fetal head that precludes vaginal delivery.
✔️Because labor dystocia can rarely be diagnosed with certainty, the relatively imprecise term “failure to progress” has been used, which includes lack of progressive cervical dilation or lack of descent of the fetal head or both.
✔️This may be due to fetal malposition or malpresentation rather than a true disparity between fetal size and maternal pelvic dimensions.
➡️However, true CPD may occur if the fetus has a large surface anomaly (eg, teratoma, conjoined twin), the maternal pelvic anatomy is not conducive to fetal passage or is deformed (eg, after pelvic trauma), or the fetus is extremely large.
✔️CPD is a subjective clinical assessment based on physical examination and course of labor.
➡️It usually manifests as a prolonged second stage.
➡️It may also manifest as failure of the head to engage into the pelvis.
✔️Antepartum, the clinician is generally unable to predict maternal pelvis/fetal size discordance leading to arrest of labor requiring cesarean birth.
➡️Clinical and radiologic assessments of the maternal pelvis and fetal size (ie, pelvimetry) are inexact and poorly predict the course and outcome of labor, except at the extremes of pelvic contraction or excessive fetal size.
➡️Radiographic pelvimetry is not recommended.
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