* Study by Abisowo OY et al showed that main reason for LSCS was cephalopelvic disproportion
followed by foetal distress among both groups.
Though cephalic molding has not been evaluated in this study, the likelihood is that molding was present in these babies with large head circumference because the functional capacity of the pelvis inlet may have been inadequate to allow the fetus to negotiate the birth canal due to cephalopelvic disproportion
as evidenced by significantly increased odds ratios for prolonged or obstructed labor (p < 0.001) beyond 75% centile z-score bands of the morphometric index (Table 3).
Self-Ratings of most important maternal reasons in decision making for CS delivery # Reason n % 1 Hypertensive disorders 34 60% 2 Abnormal labor pattern or arrest in progress of labor 31 54% 3 Previous cesarean section 19 33% 4 Cephalopelvic disproportion
19 33% 5 Maternal request 18 32% 6 Maternal complications 12 21% 7 Malpresentation of Fetus 12 21% 8 Diabetes mellitus 11 19% 9 Abnormal fetal well-being parameters 11 19% 10 Fetal macrosomia 6 11% Other causes 46 81% Missing 5 9% Total 57 100% Table 3.
CPD, cephalopelvic disproportion
; C/S, cesarean section; IM, intramuscular; IQR, interquartile range; NRS, numerical rating scale; P, percentile; SD, standard deviation.
The term cephalopelvic disproportion
is used to describe a disparity between the dimensions of the fetal head and maternal pelvis, which translates into a slowing or halting of cervical expansion and descent of the fetal head, despite the presence of adequate uterine contractions, thereby preventing a vaginal delivery (Pinango Cruz et al., 2006).
Reasons for failed vacuum extraction (4) Instrument Technique Clinical circumstances Pump failure Failed maternal valsalva Congenital anomaly Vacuum leak Inappropriate intensity Macrosomia or unappreciated or axis of traction cephalopelvic disproportion
Maternal tissue Incomplete cervical entrapment dilation Poor cup position Minor degrees of malposition
On the other hand, women who had a prior cesarean delivery for cephalopelvic disproportion
or failure to progress have been shown to have lower TOLAC success rates ranging from 50% to 67%.
The most common indications for caesarean delivery were prior caesarean delivery (23.9%), cephalopelvic disproportion
or obstructed labour (22.0%) and non-reassuring fetal heart rate (19.7%).
She underwent cesarean delivery 3 years back for cephalopelvic disproportion
under subarachnoid block without any perioperative complications.
Singleton pregnant women at a gestational age of 37-42 weeks, cephalic presentation, 4-5 cm cervical dilatation with spontaneous onset of labor, and with no history of previous high-risk pregnancy, cesarean section, cephalopelvic disproportion
, or narcotic use within the past eight hours were included in the study.
The most common cause of un-engaged head was deflexed head in 28(28%) women Cephalopelvic disproportion
(CPD) in 18(18) loop of the cord around the neck in 4(4%) placenta previa type 1 and 2 (anterior) in 4(4%) and hydrocephalus in 1(1%).
Abnormal fetal head positions result in the fetal head introduced with larger diameters and the presence of cephalopelvic disproportion
. (20) An abnormal fetal head position is often related to the type of pelvis.