Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Is It Safe To Have Normal Delivery When Diagnosed With Cephalopelvic Disproportion?
Question: Hi there,
My name is Dr. XXXXXXX XXXX, currently working in Medical Insurance company. I have one case of our member and need to have your expert opinion.
Chief complaints/reason for admission:
This is 43- years old female member, at 37+3 weeks of gestation. She is due for Elective Lowe Segment Cesarean Section (LSCS) due to Cephalo-Pelvic Disproportion. She is Gravida 1, Para 0, with her Last Menstrual Period (LMP) of 25th September 2014 and Expected Date of Delivery (EDD) 2nd July 2015.
Investigations:
Obstetric Ultrasound (30.05.2015):
• Estimated date of confinement is 02nd July 2015. Gestational age is 35 weeks and 2 days.
• Single live fetus in cephalic position.
• Measurements:
o Biparietal diameter 90 mm 36w4d
o Femur length 66 mm 33w6d
o Abdominal circumference 280 mm 32w0d
o Head circumference 316 mm 35w4d
o Estimated fetal weight 2166 g +/- 324 g
o Estimated gestational age 34w
o Fetal heart rate 138 bpm
o Growth percentile 7.2%
• Placenta position is posterior, maturity grade 2, and far from the internal os.
• Amniotic fluid is normal with amniotic fluid index of 17.4 cm.
• Umbilical artery Doppler with the normal range with S/D 2.9 and RI 0.66.
Diagnosis:
37 weeks of gestation with Cephalo-Pelvic Disproportion
Plan of management:
Elective LSCS due to Cephalo-pelvic disproportion
In this case, we have asked the following questions:
1. Height of the member: 163cm
2. Pre-pregnancy weight: 59.9 kg
3. Latest weight: 69.9 kg
4. 3. Why a trial of labour is not requested for this patient as the weight of the baby is less than 3. 5 kg? as per the treating doctor " after discussing the risk and benefit, patient desired to proceed with C-section.
5. How was cephalo-pelvic disproportion diagnosed in this patient: Bimanual pelvimetry
6. what criteria was used? Narrow pubic arch, prominent spines
7. Trial of labour in nulliparous women should be considered especially in average sized babies and average size pelvis. Why it was not considered? As per the treating doctor " because she will end up having C-section"
we would like to have your comments based on your experience in this field and based on International guidelines on this case, if she will require to have a trial of labor for the Normal delivery or Proceed with Elective C-section without the trial of labor.
My name is Dr. XXXXXXX XXXX, currently working in Medical Insurance company. I have one case of our member and need to have your expert opinion.
Chief complaints/reason for admission:
This is 43- years old female member, at 37+3 weeks of gestation. She is due for Elective Lowe Segment Cesarean Section (LSCS) due to Cephalo-Pelvic Disproportion. She is Gravida 1, Para 0, with her Last Menstrual Period (LMP) of 25th September 2014 and Expected Date of Delivery (EDD) 2nd July 2015.
Investigations:
Obstetric Ultrasound (30.05.2015):
• Estimated date of confinement is 02nd July 2015. Gestational age is 35 weeks and 2 days.
• Single live fetus in cephalic position.
• Measurements:
o Biparietal diameter 90 mm 36w4d
o Femur length 66 mm 33w6d
o Abdominal circumference 280 mm 32w0d
o Head circumference 316 mm 35w4d
o Estimated fetal weight 2166 g +/- 324 g
o Estimated gestational age 34w
o Fetal heart rate 138 bpm
o Growth percentile 7.2%
• Placenta position is posterior, maturity grade 2, and far from the internal os.
• Amniotic fluid is normal with amniotic fluid index of 17.4 cm.
• Umbilical artery Doppler with the normal range with S/D 2.9 and RI 0.66.
Diagnosis:
37 weeks of gestation with Cephalo-Pelvic Disproportion
Plan of management:
Elective LSCS due to Cephalo-pelvic disproportion
In this case, we have asked the following questions:
1. Height of the member: 163cm
2. Pre-pregnancy weight: 59.9 kg
3. Latest weight: 69.9 kg
4. 3. Why a trial of labour is not requested for this patient as the weight of the baby is less than 3. 5 kg? as per the treating doctor " after discussing the risk and benefit, patient desired to proceed with C-section.
5. How was cephalo-pelvic disproportion diagnosed in this patient: Bimanual pelvimetry
6. what criteria was used? Narrow pubic arch, prominent spines
7. Trial of labour in nulliparous women should be considered especially in average sized babies and average size pelvis. Why it was not considered? As per the treating doctor " because she will end up having C-section"
we would like to have your comments based on your experience in this field and based on International guidelines on this case, if she will require to have a trial of labor for the Normal delivery or Proceed with Elective C-section without the trial of labor.
Brief Answer:
Doctor is right in judgement
Detailed Answer:
Hello doctor,
Thanks for your query.
I have read you query and I understand your concerns about possibility of normal labour.
Following is my reply:
1) Feasibility of normal delivery versus C section can be decided by the attending gynecologist by doing bimanual pelvimetry.
2) If doctor feels space is not adequate and the patient has no likely chances of normal delivery, doctor can advice C section for patient especiaaly if patient agrees to it and has no problem.
3) If normal labor is allowed even if CPD was diagnosed, and if there is a complication during labour leading to harm to mother or baby, doctor is held responsible.
4) In such situation, with doctor's knowledge, it correct judgement to advice elective C- Section as doctor feels its gross CPD and cannot be allowed for labour and associated complications.
I hope I answered you query and addressed your concerns.
Let me know if you wish to ask any further questions. I will be glad to help you.
Regards,
Dr. Mahesh Koregol
Doctor is right in judgement
Detailed Answer:
Hello doctor,
Thanks for your query.
I have read you query and I understand your concerns about possibility of normal labour.
Following is my reply:
1) Feasibility of normal delivery versus C section can be decided by the attending gynecologist by doing bimanual pelvimetry.
2) If doctor feels space is not adequate and the patient has no likely chances of normal delivery, doctor can advice C section for patient especiaaly if patient agrees to it and has no problem.
3) If normal labor is allowed even if CPD was diagnosed, and if there is a complication during labour leading to harm to mother or baby, doctor is held responsible.
4) In such situation, with doctor's knowledge, it correct judgement to advice elective C- Section as doctor feels its gross CPD and cannot be allowed for labour and associated complications.
I hope I answered you query and addressed your concerns.
Let me know if you wish to ask any further questions. I will be glad to help you.
Regards,
Dr. Mahesh Koregol
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
