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Cephalopelvic Disproportion - Negligence Claim
Thousands of clinical compensation claims are initiated every year in the United Kingdom by medical negligence solicitors on behalf of people from all walks of life. A multitude of operations and procedures are executed successfully however a small percentage do go wrong, laying the grounds for medical negligence solicitors to take legal action in order to claim compensation. Both legal aid and the no win no fee scheme are available to pursue medical negligence compensation claims.
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Not every delivery goes as planned. The condition of cephalopelvic disproportion can result in prolonged labor, delayed second stage of labor and even fetal distress. The term, cephalopelvic disproportion means that the head or "cephalus" of the infant does not fit as planned in the maternal pelvis. The woman can push and push without reasonable lowering of the fetal head in the pelvis. In some cases, it only results in a prolonged labor or second stage of labor. In other cases, it results in a complete cessation of the progress of labor so that the mother needs a cesarean section.
It is not always easy to know in advance that cephalopelvic disproportion is going to happen. One can do an ultrasound at term and measure the size of the fetal head. If the fetal head is large, one can infer that cephalopelvic disproportion is going to happen but it is difficult to use the ultrasound to measure the size of the pelvic inlet or outlet. It is only when things are going extremely slowly that it can be determined whether or not the pelvis is going to be adequate for the fetal head.
There are numerous causes of cephalopelvic disproportion. One possibility is increased fetal weight. If the fetal weight is going to be ten pounds or more, one can expect that cephalopelvic disproportion can occur. If the gestational age is 42 weeks or more, the head can be too big. If the mother is diabetic, the infant is expected to be bigger than average. If a woman has had a great deal of children, the subsequent children tend to be bigger and one or more can result in cephalopelvic disproportion.
The position of the fetus can play a role in cephalopelvic disproportion. If the infant is in the occiput posterior position with the back of the head facing the tailbone, it can fail to fit inside the pelvis. A brow presentation and a face presentation are more serious positions of the fetus that can impact the ability of the fetus to pass through the birth canal.
The size and shape of the pelvis can play a role in cephalopelvic disproportion. If the pelvis is small due to small maternal frame, there can be problems with the passage of the infant through the birth canal. If the shape of the pelvis is abnormal due to osteomalacia, rickets, previous trauma or tuberculosis, there can be problems fitting the head through the pelvis. Tumors of the pelvic bones, congenital poliomyelitis, congenital hip dislocation or congenital deformity of the sacrum or coccyx can obstruct the birth passage.
The genital tract itself can impact cephalopelvic disproportion. For example, fibroid tumors can block the birth passage. If the cervix is too rigid, the head will not be able to expand it so the head will stay in the uterus. Scarring of the cervix will do the same thing. If a woman has a congenital vaginal septum, the head may not fit through the cervix and there will be cephalopelvic disproportion.
As mentioned, it is not easy to detect the presence of cephalopelvic disproportion early enough to do something about it, such as scheduling a cesarean section before the trial of labor. The fetal head, even if it is large, can mold the bones so that it fits within the birth canal. It is also hard to predict the amount of ligament stretching and molding of joints that can occur in the woman giving birth. Most doctors recommend a trial of labor for all women, even if cephalopelvic disproportion is suspected.
The biggest problem with the "trial of labor" is that fetal distress can occur with an infant stuck in the birth canal. This necessitates an emergency cesarean section and the possibility of brain injury to the infant is higher than with a normal delivery.