Cephalopelvic disproportion is when a baby’s head is too large to fit through the mother’s pelvis during childbirth. What is referred to as “true” cephalopelvic disproportion (CPD) is simply when either the baby’s head is too large, or the mother’s pelvis is too small for the baby to fit through the pelvis. Sometimes obstetricians use a diagnosis of CPD more widely to explain a wide variety of obstructed labor scenarios.
Obstructed labor, or labor dystocia, means that the baby is not moving through the pelvis because, for whatever reason, it is stuck. Complications can quickly arise in this scenario that can seriously injure the baby, namely oxygen deprivation. C-sections are a safe solution to this problem.
Failure to recognize and appreciate the danger of the clinical presentation of probable cephalopelvic disproportion is medical malpractice if harm is caused to the child. Sometimes doctors do not see the problem when they should or use medicine and medical devices that make the problem worse.
Babies can get stuck behind the pelvis for many reasons. They may be in the wrong position or their shoulder may become lodged on the pelvic bone. The most common cause of obstructed labor, however, is cephalopelvic disproportion.
CPD happens for one of two reasons: the baby’s head is too large or the mother’s pelvis is too small. It may sound strange that this is possible. How does this happen?
A baby can develop to be overly large in the womb. Babies larger than 8lbs 3oz are diagnosed with what is called fetal macrosomia. Macrosomia is a medical term that just means a large baby. Macrosomia was defined as a baby greater than 4,000 grams, which is about a little over 8 pounds. The definition most doctors will tell you is now 4,500 grams. Macrosomia comes with risks so the OB/GYN must be on-guard for warning signs if the baby's measurements and history cause doctor to raise her antenna.
The condition is most commonly caused by gestational diabetes. One in five pregnant women is affected by gestational diabetes. One in ten pregnancies are affected by macrosomia. Up to half of all pregnancies involving gestational diabetes are complicated by macrosomia. Other risk factors for macrosomia include:
- Type 1 or 2 diabetes
- Male babies
- Post-term pregnancies (the baby is late)
- Maternal obesity or weight gain
- History of fetal macrosomia or genetic factors (e.g. if mother had macrosomia when they were born)
- Previous pregnancies (multiparity, risk of macrosomia increases with each pregnancy)
A mother may have a small pelvis or other complications involving the pelvis that could cause cephalopelvic disproportion. The following are some of the possible explanations as to why a mother’s pelvis may not easily accommodate vaginal birth:
- Genetic factors
- Adolescent or petite mother
- Prior injury to the pelvis
- Growths on pelvis
- Pelvic malformation
Just because a mother is petite or a baby is especially large does not mean that vaginal birth is impossible. Mostly, it is possible. This is because the baby’s head bones shift and adjust to the pressure of the birth canal, allowing it to safely pass through a small space.
Still, the ratio of fetal head circumference to the obstetric conjugate may be the best predictor of cephalopelvic disproportion and a good way to diagnose CPD. What is the obstetric conjugate? The obstetric conjugate is the distance between the sacral promontory and the inner pubic arch. Because if a baby is growing abnormally fast, it "macrocosmic," that can create a lot of problems during the delivery process, during the birthing process.
So tools like ultrasounds and pelvimetry, a method of imaging the mother’s pelvis, can predict CPD and help confirm a diagnosis. These tools are not exact. But they can alert doctors when there may be a risk of CPD.
Other risk markers for CPD include maternal age and weight, pregnancy age, height,, and prior history of pregnancies.
Most cases of cephalopelvic disproportion are diagnosed as labor progress. Doctors should carefully a mother’s labor, especially when there is a risk of CPD. The obstetrician needs to keep tabs on the baby’s heart rate and movement through the birth canal.
If the baby does not move past the pelvis in a reasonable amount of time or if the baby appears to be in distress, a diagnosis of cephalopelvic disproportion may be made.
There are tools at an obstetrician’s disposal when dealing with a vaginal birth that is not progressing. The doctor may use a drug to induce labor, such as Pitocin. Such drugs stimulate labor so that labor progresses more quickly. Additionally, doctors can use forceps or vacuum extractors. These are devices that allow doctors to move a baby’s head inside the birth canal and guide the baby out.
However, with true cephalopelvic disproportion, other methods may be unsuccessful, and a C-section must be performed to quickly deliver the baby through an incision in the mother’s abdomen. The most important thing doctors must do is assess whether a vaginal delivery is advisable, what the risks of each delivery technique are, and the course of action that presents the least risk and the best outcome for the mother and baby.
Cephalopelvic disproportion can lead to serious birth injuries if not taken seriously or effectively treated. Birth injuries from CPD are typically the result of oxygen deprivation from prolonged labor, leading to conditions like cerebral palsy. Other injuries may result from the use of instruments like vacuum extractors.
With cephalopelvic disproportion, C-section delivery is the best option, given that the baby’s head has little to no chance of fitting past the pelvis. It is a fast procedure, eliminating the need for multiple attempts at vaginal delivery which can be immensely stressful for the mother and baby.
One common decision that leads to malpractice with cephalopelvic disproportion is using another mechanical device after the first one fails. Trying multiple times to achieve vaginal delivery using different methods increases the odds that an injury will occur to the child or the mother. More than one failed attempt to deliver vaginally indicates CPD, meaning that vaginal delivery is unlikely to be successful.
Another mistake is the use of drugs to induce labor when there are indications of CPD. If there are signs of cephalopelvic disproportion, Pitocin should not be given. A doctor can only rule out cephalopelvic disproportion by examining the patient thoroughly. Doctors who use Pitocin injudiciously can cause uterine hyperstimulation and iatrogenic fetal distress that may make CPD and shoulder dystocia an insurmountable challenge.
Below are examples of past settlements amounts and jury payouts in lawsuits involving cephalopelvic disproportion and medical negligence. While there are too many unique factors at play to try to predict the value of an individual claim, these examples can help you better understand the potential value of your claim.
- 2018, Ohio: $11,350,000 The plaintiff’s baby is born with hypoxic-ischemic encephalopathy as a result of a prolonged delivery. After unsuccessful attempts at pushing, the obstetrician decides to use forceps and a vacuum extractor to deliver the baby, who is stuck in the birth canal. After delivery, Apgar scores are recorded at one and five, making resuscitation necessary. The baby sustains hypoxic-ischemic encephalopathy. His parents hire a cephalopelvic disproportion malpractice lawyer to sue the obstetrician for failing to respond to fetal heart rate changes, diagnose CPD, and obtain informed consent for a vaginal delivery. The parents hire a cephalopelvic disproportion malpractice lawyer and files a lawsuit. The suit claims that a test performed when the child was two years old confirms brain damage and injuries that resulted from the extended and traumatic delivery. The 16-year-old boy’s cognitive, motor, and social functions are adversely impacted as a result. The jury awards $11,350,000.
- 2017, Colorado: $4,000,000 The plaintiff is admitted to the hospital for induced labor due to her small size and her fetus’ large gestation size. The labor and delivery nurses administer Pitocin and perform an assisted membrane rupture about 45 minutes after administration. After ten hours, her labor does not progress. Then, the plaintiff enters the active pushing phase. The baby does not successfully descend after two and a half hours because of cephalopelvic disproportion. The OB-GYN decides to perform a vaginal delivery via vacuum extraction. However, the mother does not provide informed consent before his decision. The OB-GYN fails to locate the vertex when he places the vacuum on the baby’s head. The device comes off multiple times. Within 15-20 minutes of pulling, the baby is born. He displays bruising on his skull and scalp abrasions. He also appears unresponsive. His function is diminished, and he shows depressed Apgar scores. At two minutes old, he is intubated and transferred to the NICU, where he undergoes brain cooling to treat the trauma that the vacuum extraction caused. Ultimately, the boy sustains a severe permanent brain injury. Despite undergoing treatment and therapy for eight years, he is mentally disabled, has reduced cognition, and is in his school’s special education program. The jury awards the family $4,000,000 in damages.
At Miller & Zois, our attorneys understand that this is a difficult time for parents. Our medical malpractice lawyers can help parents receive compensation for the negligent care they and their child received. For a free consultation of your case, call us at (800) 553-8082 or tell us what happened online.Medical Literature on Cephalopelvic Disproportion
- “Risk factors and perinatal outcome of pregnancies complicated with Cephalopelvic disproportion: a population-based study” by Oren Tsvieli, Ruslan Sergienko, & Eyal Sheiner, Archives of Gynecology and Obstetrics, 2012.
A study meant to characterize any risk factors and perinatal outcomes following cephalopelvic disproportion. This is another retrospective-based study that compares single deliveries of women with and without CPD between 1988 and 2010. The study concluded that in our population, the independent risk factors for CPD include fetal macrosomia (a larger-than-average baby), infertility treatment, previous cesarean delivery, maternal obesity, and polyhydramnios (excessive amniotic fluids). In pregnancies that show these types of complications, doctors should take extra care when labor begins.
- “Anthropometric measurements as predictors of Cephalopelvic disproportion: Can the diagnostic accuracy be improved?” by Dr. Santosh Benjamin, Anjali B. Daniel, Asha Kamath, & Vani Ramkumar, Acta Obstetricia et Gynecologica Scandinavica, 2011.
An assessment of the efficacy of anthropometric measurements and clinical estimates of fetal weight as predictors of Cephalopelvic disproportion (CPD). The main outcome showed that these were the highest positive predictive measurements for CPD – maternal height, foot size, the distance between the mother’s femur bones, and the distance between the outermost points of the baby’s shoulders. The study concludes that combining maternal measurements with clinical estimates can enhance predictive value to a modest degree, although CPD can never be predicted with certainty as it depends on several other maternal and fetal factors, such as the degree of ‘stretch’ in the mother’s pelvis, the capacity of the baby’s head to mold, the woman’s positioning during labor, and the fetal position. However, maternal measurements are still important because they can help identify a potentially difficult labor with serious complications.