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At least 19 recordsLinked to original sources
PubMed2003

A new predictor of cephalopelvic disproportion?

Cephalopelvic disproportion (CPD) is a recognised obstetric problem with potential risk to both mother and infant. Identification of those mothers at risk of CPD is difficult and has concentrated in the past on such measurements as maternal shoe size and height. Our objective in this study was to examine new anthropomorphic parameters as indicators of CPD. This was a case controlled study of sixty consecutive women, and their partners, who had caesarean section performed for CPD and 60 case matched controls. Measurements included maternal and paternal head circumference, height, shoe-size, body mass index (BMI), infant weight and head circumference. Parity, gestation at delivery, and mode of onset of labour were recorded. Data were analysed using Stata Release 6. Prognostic factors were tested for association with CPD using conditional logic regression. The most important anthropomorphic risk factors for CPD were maternal head circumference in relation of height (P < 0.001), and paternal head to height ratio (P = 0.017). Head to height ratio is taken as the head circumference in centimeters divided by the height in metres. Body mass index was higher in CPD cases (maternal case mean = 27.1, control mean = 25.5; paternal case mean = 27.2, control mean = 26.2). Infant head circumference was not a predictor. Primiparity was an important independent predictor (P<0.001), regardless of the mode of onset of labour. Maternal or paternal shoe-size, induction of labour and gestation at delivery were not predictors. The risk profile for CPD which emerges is one of a tall father where both mother and father have large head-to-height ratios.

Adult↗
PubMed1993

An analysis of the prediction of cephalopelvic disproportion.

Since cephalopelvic disproportion inevitably leads to cesarean section it seems to be mandatory to identify patients with an absolute discrepancy between the size of the fetus and the birth canal in order to avoid unnecessary trials of labour. In a case control study, comparing a group of patients who delivered by cesarean section because of cephalopelvic disproportion with an age matched control group, routinely assessed pelvic measurements and measurements of the newborn were correlated to cephalopelvic disproportion. Multivariate linear regression was applied to each group to determine, which of the maternal and fetal factors had the strongest influence on the mode of delivery. In the study group external conjugate showed the strongest positive relation to maternal body height (P < 0.01), the biparietal diameter of the newborn was negatively correlated (P < 0.01). None of the analyzed variables reached statistical significance in the control group. Differences between the two groups were marginal, thus providing no safe basis for decision making even in a population at high risk for developing cephalopelvic disproportion.

Adult↗
PubMed1991

The cephalopelvic disproportion index. Combined fetal sonography and x-ray pelvimetry for early detection of cephalopelvic disproportion.

The smallest pelvic diameter (either the anteroposterior of the inlet or the bispinal of the midpelvis) was determined with x-ray pelvimetry and compared to the biparietal diameter of the fetal head at term as determined with sonography. The difference between the two indicates how much wider the smallest diameter of the bony pelvis is than the fetal skull and was termed the cephalopelvic disproportion index. Vaginal delivery was impossible when the index was less than 9 mm and impossible or very difficult when between 9 and 12 mm. When it was greater than or equal to 13 mm, 26% needed a cesarean section, 19% had a difficult vaginal delivery, and the rest delivered vaginally with minimal or no difficulty. This technique clearly indicates when a vaginal delivery is impossible (index less than 9 mm) or very difficult (index less than 13 mm). The specificity was 100%. The index therefore can recognize, before labor, the cases of obvious cephalopelvic disproportion that contraindicate a trial of labor. It does not indicate, however, if a vaginal delivery is possible in the setting of a high index (sensitivity, 51%) because of the interference of other factors besides the cephalic and pelvic bony dimensions considered here. The index may prove most important in determining if a vaginal birth should occur after a cesarean section because it can clearly identify some patients who need a repeat cesarean section.

Delivery, Obstetric↗
PubMed2000

Maternal height and external pelvimetry to predict cephalopelvic disproportion in nulliparous African women: a cohort study.

OBJECTIVE: To assess external pelvimetry and maternal height, as predictors of cephalopelvic disproportion. DESIGN: Prospective cohort study. SETTING: Four hospitals in Zaire. POPULATION: Six hundred and five nulliparous women. METHODS: Maternal height and external pelvimetry were assessed during the third trimester antenatal visit. Cut off values for considering women at risk for cephalopelvic disproportion were height < 150 cm and external pelvic distances < 10th centile for the population. Logistic regression analysis, combining height and pelvic measurements, was performed to predict women at risk for cephalopelvic disproportion. MAIN OUTCOME MEASURE: Cephalopelvic disproportion was considered when there was caesarean section for failure to progress, vacuum or forceps delivery or intrapartum stillbirth. RESULTS: Cephalopelvic disproportion was present in 42 women. In univariate analysis, height, intertrochanteric diameter and the transverse diagonal of Michaelis sacral rhomboid area were found to be associated with cephalopelvic disproportion. Logistic regression analysis showed that maternal height < 150 cm and/or transverse diagonal < 9.5 cm were the variables most associated with cephalopelvic disproportion. The adjusted odds ratios were 2 x 2 (95% CI 0.9 to 5.4) and 6.5 (95% CI 3.2 to 13.2), respectively. The positive predictive value and likelihood ratio were 24% and 4.0 (95% CI 2.8 to 5.8), respectively. The addition of transverse diagonal to maternal height increased the sensitivity in predicting cephalopelvic disproportion from 21% to 52%. CONCLUSION: In addition to height, transverse diagonal measurement is able to predict one out of two cases of cephalopelvic disproportion in nulliparous women. After validation in a separate cohort, this simple predictive method may be used in peripheral centres for timely referral of pregnant women at risk for cephalopelvic disproportion.

Adult↗
PubMed1998

First delivery after cesarean delivery for strictly defined cephalopelvic disproportion.

OBJECTIVE: To examine the outcome of trial second labor after a first cesarean performed because of cephalopelvic disproportion, defined according to strict diagnostic criteria. METHODS: Obstetric details of nulliparous women delivering at 37 or more weeks' gestation by cesarean for cephalopelvic disproportion, between 1975 and 1990, were recorded prospectively. The diagnostic criteria for cephalopelvic disproportion were cervical dilation arrested after 5 cm, unresponsive to oxytocin augmentation, after active dilatation of 2 cm or more in 2 hours. Fetal malpresentations and malpositions were excluded. The outcome of next delivery in our hospital by each woman enrolled was then examined. RESULTS: Eighty-four of 42,793 women met the criteria for disproportion, and 40 with cephalic presentations delivered their next baby in our hospital. All 40 underwent a trial of labor and 27 (68%) delivered vaginally, comprising seven (47%) women with larger second and 20 (80%) with smaller second babies. Of 15 women previously delivered by cesarean at full dilatation, 11 (73%) delivered vaginally with no serious maternal or neonatal morbidity. CONCLUSION: The strictly defined diagnosis of nulliparous cephalopelvic disproportion should not constitute an automatic "recurrent" indication for elective cesarean delivery, because 68% of patients in our series had successful vaginal deliveries in their next pregnancies. This rate is similar to those reported after all nulliparous cesareans for dystocia.

Cesarean Section↗
PubMed1997

Combination of ultrasound pelvimetry and fetal sonography in predicting cephalopelvic disproportion.

OBJECTIVE: To assess a method of antepartum diagnosis of cephalopelvic disproportion by comparing the diameters of fetal head with those of the maternal midpelvis. METHODS: Transvaginal ultrasound pelvimetry was performed on 190 healthy primigravidas with cephalic presentation at 28-35 weeks of gestation, and the fetal heads were measured within one week before delivery. The cephalopelvic indices of diameter, circumference and area were calculated and compared. RESULTS: The index exhibiting the highest degree of accuracy (77.9%) was the cephalopelvic index of diameter (CID) defined as the difference between the mean diameter of the midpelvis and the fetal biparietal diameter (BPD). Eighty-three percent of the cases with CID less than 15.8 mm needed operative delivery, and 76.2% of the cases with CID more than 15.8 mm underwent vaginal delivery. CONCLUSIONS: The CID may be used to identify cephalopelvic disproportion before the labor and help obstetricians choose the most appropriate form of delivery in an uncomplicated vertex presentation.

Cephalometry↗
PubMed1998

[Prediction of cephalopelvic disproportion by ultrasonographic cephalopelic].

OBJECTIVE: To develop a prospective antepartum method of identifying cephalopelvic disproportion by comparing the diameters of fetal head with those of the maternal midpelvis. METHODS: Transvaginal ultrasound pelvimetry was performed on 190 healthy primigravidas with cephalic presentation at 28-35 weeks of gestation, and the diameters of their fetal heads were meassured within one week prior to delivery. These indices the cephalopelvic indices of diameter, cirumference and area, were calculated and compared. RESULTS: The cephalopelvic index of diameter (CID), defined as the difference between the mean diameter of the midpelvis and the fetal biparetal diaameter (BPD), showed the highest degree of accuracy (77.9%). Eighty three percent of women with CID less than 15.8 needed operative delivery; 76.2% of those with CId more than 15.8 mm underwent vaginal delivery. CONCLUSIONS: Transvaginal ultrasound pelvimetry and the CID by and large seems to be able to identify cephalopelvic disproportion before labor and may help obsetricians choose the most appropriate form of delivery in an uncomplicated vertex presentation.

Adult↗
PubMed1995

[Analysis of 100 cesarean section with indication of cephalopelvic disproportion].

A retrospective analysis on the 100 cases cesarean section with indication of cephalopelvic disproportion was carried out in Beijing Obstetrics and Gynecology Hospital, From March to October in 1992, there were 73 cases were performed operation with correct diagnosis and management, another 27 cases were required further discussion, such as too early intervention of the delivery in laten phase in 8 cases, improper observation and management in active phase in 19 cases. Therefore we suggest that the diagnosis of cephalopelvic disproportion should be carefully after observation in labor stage and sufficiently trials of labor. It may decrease the rate of cesarean section and increase the obstetric quality.

Adult↗
PubMed1983

A mathematical approach to problems of cephalopelvic disproportion at the pelvic inlet.

So many problems have been left unsolved by x-ray pelvimetry for the prognostic diagnosis of cephalopelvic disproportion that the clinical usefulness of x-ray pelvimetry has been questioned and a more scientific approach to evaluation of cephalopelvic disproportion has been sought. By unifying various factors that impose problems in cephalopelvic relationships into one index via new mathematical models, we attempted to estimate quantitatively the potential dystocia caused by inlet disproportion. The index is calculated from ten measurements of data obtainable on roentgenograms, and the practical calculations can be readily done with a programmable calculator. The validity of the assumptions used in the mathematical models and the reliability of the developed index were retrospectively analyzed in 300 primiparous women with cephalic presentations. This study suggests that the mathematical index could serve as a useful prognostic guide to the proper management of labor in association with disproportion.

Cephalometry↗
PubMed1986

Factors related to the increasing cesarean section rates for cephalopelvic disproportion.

At the Highland Park Hospital the increase in cesarean section rates has paralleled the national increase. Data from cesarean deliveries performed for cephalopelvic disproportion (a leading reason for cesarean section) in 1969 to 1972 (group 1) and 1979 to 1982 (group 2) were evaluated to determine maternal, fetal, and delivery factors that might be related to the increase in the rates. The data suggested that the more frequent diagnosis of cephalopelvic disproportion and the increased size of the group 2 infants were the primary reasons for the increase in cesarean section rate. This increased rate was paralleled by a decline in forceps-assisted delivery and in perinatal mortality rates.

Adult↗
PubMed2006

Clinical practice guideline for cesarean section due to cephalopelvic disproportion.

OBJECTIVES: To evaluate the effect of the Clinical Practice Guideline (CPG) for cesarean section due to Cephalopelvic Disproportion (CPD) on physician compliance, pregnancy outcomes and cesarean section rate. The study also wants to identify factors associated with physician non-compliance. MATERIAL AND METHOD: 455 medical records of women undergoing a cesarean section due to CPD from January 1, 2002 to December 31, 2003 were reviewed The CPG was implemented on January 1, 2003. The pregnant outcomes of women who delivered from January 1, 2002 to December 31, 2002 were used for comparison. The outcome measurements were physician compliance, pregnancy outcomes and cesarean section rates. Multivariate logistic regression analysis was used to identify factors associated with physician non-compliance. Independent variables included private care, parity, maternal height, Bishop score, maternal age and estimated fetal weight. RESULTS: The compliance rate was 83%. Physician compliance in private practice was lower than in non-private practice (76.6% VS 92.4%). Pregnancy outcomes were not different between the two periods. The cesarean section rates before and after implementation of the CPG were 8.4% and 8.5%, respectively. Private practice, poor Bishop score and estimated fetal weight < or = 3500 g were significant predictors of physician non-compliance. CONCLUSION: The compliance rate was high, but the cesarean section rate due to CPD did not significantly change within a one year period There was no adverse outcome. Physician non-compliance was more common in private practice. Poor Bishop score and high estimated fetal weight were significant predictors.

Adult↗
PubMed2006

Cephalopelvic disproportion is associated with an altered uterine contraction shape in the active phase of labor.

OBJECTIVE: The purpose of this study was to determine if intrapartum contractions of a particular shape (rapid rise with slower return to baseline) are predictive of cephalopelvic disproportion (CPD). STUDY DESIGN: In an institutional review board (IRB)-approved study, cohorts of 100 women who underwent spontaneous vaginal delivery (SVD) and 100 who underwent cesarean section (C/S) for CPD or arrest of labor were consecutively identified between January 2004 and March 2005. Inclusion criteria included term, singleton pregnancies, nulliparity, and absence of fetal anomalies. One hour of interpretable electronic fetal monitoring (EFM) was obtained in active labor. Fall to rise (F:R) ratio was calculated by measuring the time for a contraction to return to its baseline from its peak ("fall") and the time for a contraction to rise to its peak ("rise"). The F:Rs were then averaged over the number of contractions. Data were analyzed using Student t test, Chi-square, and Fisher exact tests where appropriate. RESULTS: Maternal demographics are listed in Table I. The average F:R ratio was 1.55 for SVD versus 1.77 for C/S, a statistically significant difference (P = .00003). Analysis of variance revealed this difference persists when controlled for the potentially confounding factors shown. At F:R >1.76, moreover, there was a trend towards larger birth weight (P = .06). CONCLUSION: Our study demonstrates there is a difference in uterine contraction configuration that is more common in those labors destined for C/S due to CPD. This may indicate the presence of a heretofore unknown feedback mechanism as the uterus adapts to the dysfunctional labor.

Adult↗
PubMed1991

Short stature and cephalopelvic disproportion in Burkina Faso, West Africa. Operations Research Team.

In order to reduce maternal mortality due to cephalopelvic disproportion (CPD), it is important to screen women for short stature, especially in rural areas of developing countries. We measured the height of 1733 women as they left the maternity services in Ouagadougou and recorded the type of delivery. Women less than 155 cm tall were 4.9 times more likely to have a cesarean section delivery. We propose simplified screening criteria for use by traditional birth attendants.

Body Height↗
PubMed1983

Assessment of the predictive value of X-ray pelvimetry and biparietal diameter in cephalopelvic disproportion.

The value of X-ray pelvimetry and ultrasonic measurement of the biparietal diameter for trial of labor prognosis was assessed in 172 healthy primiparas with suspected cephalopelvic disproportion. A decision diagram which is able to correctly predict 50% of the cesarean sections without increasing the number of unnecessary cesarean sections is proposed. In addition, the study confirms the superfluity of X-ray pelvimetry in cases of high station of the fetal head at the end of pregnancy.

Apgar Score↗