Cephalopelvic disproportion (CPD) can develop because of a size disproportion when the child’s head misaligns with the mother’s pelvis during childbirth. The risk factor increases when the newborn is too big to fit into the mother’s pelvis during delivery when the infant must navigate their head to get through the birthing canal successfully.
Cephalopelvic disproportion causes the baby to twist their way through the pelvis instead of dropping through the birth canal. When the child becomes stuck, the potential risk of depriving the newborn's brain of oxygen can cause catastrophic injuries or death. While this type of birth trauma tends to happen in other countries more than America, it still presents a serious medical problem that can be avoided through early diagnosis and medical preparation.
Rosenfeld Injury Lawyers LLC represents children injured at birth related to conditions such as cephalopelvic disproportion. Our attorneys appreciate the impact a disabled child can have on the entire family. If you believe your child's cerebral palsy is related to cephalopelvic disproportion and the physician failed to intervene, contact our office for a free review of your legal rights and options.
Cephalopelvic Disproportion Risk Factors
Many doctors will diagnose CPD after the child has experienced prolonged labor. The most common problems risk factors associated with CPD include:
- Failing to Progress – Some newborns, during the most crucial part of the delivery process, are unable to pass through the vagina because they are too large (macrosomia) and are at risk for injury or becoming lodged in the birth canal. Without immediate intervention, CPD can cause the child to suffer shoulder injuries or asphyxia (lack of oxygen). In an effort to intervene, the doctor might elect to use assistive medical tools including extraction vacuums and forceps to pull the newborn out of the birth canal. Unfortunately, these tools are known to cause severe and often permanent injuries to the newborn while posing a severe threat of perineal tearing, vaginal tearing, tell bone fractures, or excessive bleeding to the mother.
- Ruptured Uterus – Although it's rare, CPD can lead to the mother’s ruptured uterus if she had previously undergone a cesarean section when delivering another baby. These tears usually occur along the scar line from an earlier pregnancy or surgical procedure.
- Post-Delivery Bleeding – Cephalopelvic disproportion increases the potential risks of the uterus not properly contracting after the birthing process, which can result in excessive, life-threatening bleeding.
Causes of CPD
Approximately one out of every 250 vaginal births involve cephalopelvic disproportion, and many of those result in serious birth injuries including Erb’s palsy and cerebral palsy. Cephalopelvic disproportion can be caused by numerous factors including:
- Maternal Diabetes Mellitus (DM) – Pregnant mothers who have gestational diabetes or type II diabetes (diabetes mellitus) pass elevated insulin and blood sugar levels to the fetus which stimulates growth and causes fetal macrosomia where the baby grows to a higher than average size.
- Abnormal Fetal Presentation – Breach babies are more susceptible to suffer serious complications involving CPD that could lead to asphyxia and cause cerebral palsy or another serious health condition.
- Post-Maturity – The fetus can continue to grow if the pregnancy extends past 40 weeks, which increases the potential risk of the baby becoming lodged in the mother’s pelvis during delivery.
- Multi-Parity – The size and weight of subsequent babies after the first pregnancy and up to five pregnancies will be approximately four ounces heavier each time. The additional birthweight of multiparity increases the potential risk of the child becoming lodged in the birth canal during the birthing process.
- Small Pelvis – Any pregnant woman with a small pelvic area giving birth to a large-size baby runs the risk of severe complications resulting in cerebral palsy due to asphyxiation.
- Abnormally-Shaped Pelvic Bones – Any abnormality of the mother’s pelvic bones could create an obstacle that restricts the baby from exiting the birth canal successfully. If the birthing process becomes completely halted during a vaginal delivery, it can create an impossible, dangerous scenario where the only remedy to successfully saving the life and health of the child requires a cesarean section. Additionally, pregnant mothers with congenital tailbone deformity are at risk of experiencing CPD.
- Older and Shorter Women and Pregnancy – Pregnant mothers 35 years and older are at higher risk of experiencing complications associated with cephalopelvic disproportion, as are women who are 5’2” and less in height.
- Pelvic Bone Osteomalacia – The results of a successful delivery can become catastrophic if the pregnant mother’s pelvic bones become softened from a vitamin D or calcium deficiency.
- Severe Maternal Medical Condition – Tuberculosis, rickets, or an earlier pelvic trauma could create the scenario for cephalopelvic disproportion.
- Uterine Fibroid Tumors and Pelvic Bone Tumors – Cancerous or benign pelvic bone tumors and uterine fiber tumors can cause sizable obstructions inside the birthing canal that can restrict the baby’s ability to exit the vagina during the birthing process.
- Improperly Dilating Cervix – CPD can occur when the mother’s cervix does not dilate properly during childbirth.
- Congenital Vaginal Septum – A malformation on partitions inside the vagina can cause serious problems during delivery that could compromise the health and well-being of the child.
- Contracted Pelvis – Pregnant mothers with a smaller than normal (1.5 cm to 2.0 cm) pelvic measurement could experience complications associated with CPD.
- Spondylolisthesis – The serious medical condition can cause complications involving cephalopelvic disproportion when a spinal bone becomes misaligned with his proper positioning from the bone below it.
- Pelvic Exostosis – A pelvis-related bony growth might cause an obstruction that restricts the baby from exiting the vaginal canal.
- Macrosomia Condition – Numerous factors including gestational diabetes, extended time in the wound, or a genetic condition can cause the child to grow much larger than normal (4000 g or 8.18 pounds) in size at the time of delivery. Large size babies can experience hydrocephalus for the baby’s brain swells with fluid, causing the fetus to develop a head too large for vaginal delivery.
Early Warning Signs
Certain common warning signs could alert the doctor that there are serious problems associated with CPD during pregnancy. These signs include:
- Excessive Amniotic Fluid Levels – Primarily, amniotic fluid is created through the baby’s urine. Early indicators of cephalopelvic disproportion often involve excessive amounts of amniotic fluid that is usually a sign that the fetus weighs more than normal at that stage of their gestational age.
- Large Fundal Height – Doctors can determine the size of the baby by measuring the distance between the pubic bone and the top of the uterus commonly referred to as a fundal height. Any larger than expected fundal height is usually an indicator that the baby is too large for vaginal delivery and will require a cesarean section to ensure a successful childbirth.
- Fetal Distress – During delivery, the fetus may become distressed if he or she is unable to successfully pass through the birth canal due to an obstruction, improperly dilated cervix, or being too large in size to fit through a narrow pelvic passageway.
- Prolonged Labor or Delivery – In some scenarios, the baby becomes lodged in the birthing canal which prolongs the length of time for labor or delivery. Without immediate medical intervention, the child could suffer serious health conditions including asphyxia (a lack of oxygenated blood) that might lead to major health problems including cerebral palsy, Erb’s palsy, or death.
Counterindications of Pitocin and CDP
The delivering obstetrician must accurately diagnose the pregnant mother before childbirth to eliminate any indicators of cephalopelvic disproportion. If the doctor is concerned that CPD might be involved, they must not give the expectant mother Pitocin, an IV drug used to increase or start uterine contractions.
Giving the mother this medication when there would be a cephalopelvic disproportion during delivery could cause iatrogenic fetal distress or uterine hyperstimulation that could lead to shoulder dystocia where the child’s shoulder becomes lodged against the mother’s pelvis. These cases tend to create an insurmountable difficulty in ensuring a successful delivery.
Unfortunately, many doctors failed to accurately diagnose conditions involving CPD and failed to use the proven methods to increase the potential chance of identifying the condition and applying proactive measures to avoid the serious complications associated with cephalopelvic disproportion. Some of the two are used to diagnose CPD include:
- Pelvimetric Testing Using Magnetic Resonance Imaging – The family obstetrician or delivering doctor can order an MRI to examine the pregnant woman’s pelvic dimensions, how the baby is positioned inside the womb, and detailed images of the birthing canal and the tissue that surrounds the baby inside the mother’s womb.
- Clinical Pelvimetric Tests – The pregnant woman’s gynecologist, obstetrician, or other medical professional can measure the size and shape of the birth canal using their hands.
- Ultrasound Tests – A medical professional can perform an ultrasound to examine the shape and size of the fetal head to acquire measurements. These dimensions can be compared to standardized growth charts to provide valuable information on the potentially serious ramifications of birthing a baby in cases that might involve cephalopelvic disproportion.
- CT (Computerized Tomography) or X-Ray Pelvimetric Tests – These pelvimetric tests can help identify the diameter of the fetal head in comparison to the mother’s pelvic bones. Many doctors avoid performing these tests because of the potential risk of harming the unborn child by radiation exposure.
If the doctor suspects CPD, they should perform a comprehensive examination of the woman’s abdomen, womb, and pelvic bones to help identify various risk factors related to cephalopelvic disproportion. The testing might involve monitoring blood glucose levels to identify gestational or type II diabetes that could be causing the baby to experience elevated levels of insulin and blood sugars resulting in abnormal growth and fetal size. The doctor might also choose to conduct non-stress testing if they believe the baby is too large for vaginal delivery. The test results will reveal fetal heart rates in response to movement.
Treating Cephalopelvic Disproportion
Identifying cephalopelvic disproportion before the child is born could provide the pregnant women with enough information to make an informed decision and avoid a vaginal birth that might not be a viable option to a successful delivery. In these events, the physician may determine that delivering the baby through the birth canal would be too risky and instead recommend a cesarean section (c-section). If the pregnancy is in its 38th week or earlier, the delivering doctor may choose to perform an amniocentesis test to help identify the stage of fetal lung development before electing to go ahead with the surgical childbirth.
In rare cases where performing a cesarean section would be harmful to the newborn, and vaginal delivery is no longer an option, the delivering doctor may recommend that the expectant mother squats in an upright position which can increase the size of the pelvic area by approximately 30%. Sometimes, the delivery doctor might perform a symphysiotomy while the mother is performing a vaginal birth by cutting the pubic bone to ensure that there is adequate space to allow the child’s head to move to the canal without becoming stock.
Immediately after the delivery, the doctor should assess the newborn for birth injuries and other serious medical conditions including low blood sugar and polycythemia (abnormally increased concentration of blood hemoglobin). If complications arise during the labor and delivery processes, the doctor might move the newborn into the NICU (neonatal intensive care unit) for ongoing treatment.
CPD and Birth Injuries
Doctors facing a delivery involving cephalopelvic disproportion must follow established protocols and treating the potentially life-threatening condition. Doing anything or allowing any severe condition to develop during labor and delivery could lead to serious medical problems for the newborn including the development of cerebral palsy, Erb’s palsy, and other conditions. Some of the complications associated with CPD include:
- Pitocin Overdose – Prescribing the expectant mother synthetic oxytocin (Pitocin) could create serious medical complications if the labor and delivery involves cephalopelvic disproportion. The drug is prescribed to speed of delivery. However, the medication has been proven to cause traumatic, excessive contractions which could immediately or eventually cause serious injuries to the newborn.
- Prolonged Labor – When the labor takes too long to progress to the next stage, it can deprive the baby of oxygen and lead to serious injuries including cerebral palsy, developmental delays, HIE (hypoxic-ischemic encephalopathy, brain bleeds (intracranial hemorrhages) and other life-threatening conditions.
- Shoulder Dystocia – When the labor and delivery process involves cephalopelvic disproportion, the newborn is likely to experience a shoulder dystocia injury that might involve Klumpke’s palsy or Erb’s palsy.
- Prolapsed or Compressed Umbilical Cord – Any decreased or constricted space inside the uterus caused by a small maternal pelvis, or abnormally large baby could deprive the newborn of much-needed oxygen that is restricted by a trapped, compressed or prolapsed umbilical cord.
CPD Cerebral Palsy - Related Injuries
If the doctor does not handle labor and delivery involving cephalopelvic disproportion properly, their negligent actions could put the newborn at risk for suffering numerous birth injuries. It is crucial that the doctor recognizes the obvious risk factors involving CPD and provide care following acceptable standards to prevent the fetus or newborn from injury.
If your child was diagnosed with an injury caused by CPD, your family is likely entitled to receive monetary compensation to recover your financial damages. An attorney working on behalf of the family can identify any failure to recognize CPD by the physician that cause the baby to die or be injured from a traumatic injury caused by a forced vaginal birth. It is crucial to speak with an attorney soon because you could lose all your rights to seek compensation if the state statute of limitations expires in your case.