There are four types of pelvis: android-shape pelvis for men mostly and other three, namely gynecoid,

anthropoid and platypelloid-shaped pelvis for women1. As for the foetal skull, three types of diameters
normally taken into consideration: (a) anterior-posterior which include occipitomental (13.5 cm),
occipitofrontal (11.5cm) and suboccipitobregatre (9.5 cm), (b) vertical (9.5 cm), and (c) transverse with
biparietal (9.5 cm) and bitemporal (8.0 cm) 2.
Cephalopelvic disproportion (CPD) is a condition in which the fetal head or mothers pelvis is of a shape,
size or positions that prevent fetal descent through the mothers pelvis. Defects in main three features
give rise to CPD. Any anomaly in fetus such as macrosomia (due to diabetes, genetic abnormality,
postmaturity or multiparity), macrocephaly and abnormal fetal position (cephalic malpresentation or
breech) and any passage disorder, namely fibroids and cervical growth result in CPD. Narrow or small
pelvic bone is the third main cause3.
Early detection of CPD is significant as to avoid fetal mortality, prevent hypoxic condition and excessive
moulding in fetal skull which will lead to permanent brain damage and to avert labor complication. But
among these, the most important reason of recognising CPD is to find out the method of delivery before
labor : either normal vaginal delivery or Caesarean to ensure both the mother and fetal safety4,5.
During antenatal examination, CPD can be diagnosed via two methods. First, pelvis is examined using
pelvimetry or ultrasound scan to find out the fetal head size, weight and pelvic dimension6. Next,
Leopolds Maneuvers is done during the third trimester and if the fetal head engagement is found to be
less than 3/5, then CPD is suspected. Even then, CPD is rarely diagnosed as some physical changes
during delivery create enough space for the fetus to descend7.
During delivery, if the stage two- labor fails to progress, as in the cervix is dilated fully (13cm) with
adequate pushing energy from maternal but no descent of the baby, then it will be suspected as CPD.
This is diagnosed by vaginal examination (to determine the position of the fetus by palpating the
fontanelle in relation to surrounding pelvic anatomy, and to assure station of head descent by relating
with ischial spines) or abdominal examination using Leopold maneuver (fetal head doesnt engage to
pelvis). If one or both of these conditions exists, then it is suspected as CPD. Findings include malposition
of fetus (face/ brow/ sinciput), severe moulding of fetal skull (where sagittal suture is unable to be felt
and not reducible) and high station (-3,-2). In the first stage of labor, CPD is diagnosed if the cervix
dilates more than 3cm and contraction is regularly for two hours, but the rate of contraction is found to
be less than 1cm per hour8,9.
These findings, once recorded, the cases will be sent for emergency Caesarean section if detected in first
or second stage of labor. If CPD is suspected even before the mother goes into labor, and the situation is
not favorable for normal vaginal delivery, planned Caesarian section will be done10.

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References:

1.

Amy Tuteur, MD. Mine is bigger than yours. http://www.skepticalob.com/2013/06/mine-isbigger-than-yours.html (accessed 24 November 2014).

2.

Prof Dr Mohd Azhar. The fetal skull. http://www.slideshare.net/MohdHanafi1/4-normal-labourand-delivery (accessed 23 November 2014).

3.

YourParenting. Labour Different pelvic shapes and what they mean for your birth experience.
http://www.yourparenting.co.za/pregnancy/birth/labour/different-pelvic-shapes (accessed 26
November 2014).

4.

Kulenthran Arumugam. A Practical Approach to Obstetric Problems for the Undergraduate, 5th
ed. Malaysia: University of Malaya Press; 2012.

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Dr. Grunebaum. Cephalopelvic Disproportion (CPD).

http://www.babymed.com/complications/cephalopelvic-disproportion-cpd (accessed 3
December 2014)

6.

Dr.Huma Rathore. Antenatal Care. https://www.academia.edu/353597/ANTENATAL_CARE

(accessed 24 November 2014).

7.

Scott, James R., et al. Cephalopelvic Disproportion (CPD). http://americanpregnancy.org/laborand-birth/cephalopelvic-disproportion/ (accessed 25 November 2014)

8.

.Dr.M.D.Mazumdar, MD. CEPHALOPELVIC DISPROPORTION ( CPD ).

http://www.gynaeonline.com/cpd.htm (accessed 23 November 2014).

9.

Christian Hoffman, MD. Cephalopelvic Disproportion (CPD).

http://pregnant.thebump.com/pregnancy/pregnancy-problems/articles/cephalopelvicdisproportion-cpd.aspx (accessed 24 November 2014).

10. Mrs. Aneesa. A seminar on preventive obstetrics. : ; 2007.

http://www.slideshare.net/5299rehan/obg-13642207 (accessed 2 December 2014).