A novel clinical tool to predict cephalopelvic disproportion (CPD), the leading mechanism of obstructed labor

Cephalopelvic disproportion (CPD) is the primary mechanism of obstructed labor, one of the five major causes of maternal mortality globally. A term literally translating to the mismatch between the fetal skull and woman’s pelvis, this condition is most felt by women who, because of poor nutrition, young age of motherhood, and/or bone-affecting disease, have an improperly developed pelvis that is unsuitable for childbirth. Interventions for CPD require high-level health care, such as intravenous medications, blood products, and surgery; without intervention, women experiencing obstructed labor are vulnerable to postpartum hemorrhage, ruptured uterus, stillbirth, fistula formation, and sepsis. We propose a simple tool that can be employed by frontline health workers to risk-stratify women early in their pregnancy as “high risk for CPD” versus “low risk for CPD.” We believe our tool meets criteria for being a low-cost technology that will improve service delivery by using objective clinical data to create demand among pregnant women for facility-based delivery. Our objective is to validate our tool in the field, toward larger goals of encouraging women to deliver in higher-level health facilities and reducing the incidence of morbidity and mortality associated with obstructed labor. The innovative nature of our proposal lies in the fact that few methods exist with predictive capacity for emergencies in maternal health, especially obstructed labor. We envision our CPD risk-stratifying tool to be useful among low-literacy community health workers, who interface with the most vulnerable of reproductive-aged women.