# Fetal-maternal disproportion

- Category: chronic
- Review status: reviewed (every claim checked against a document named on this page)
- Sources: Cesarean Delivery - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK546707/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class WD71.02 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care
- Verified date: 2026-08

## Verified against

- No dose - referral pathway, no medicine given in primary care

## Treatment metadata

- No drug therapy in primary care (Referral & Advice)

## Complete treatment card

```text
FETAL-MATERNAL DISPROPORTION
Sources: Cesarean Delivery - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK546707/ · ICPC-3
         (WONCA International Classification of Primary Care, 3rd edition) class WD71.02 - condition
         scope only, no dose · No dose - referral pathway, no medicine given in primary care
Review status: REVIEWED against the source listed above  (2026-08)

IS IT THIS? - reference only, to read alongside your own examination
  SYMPTOMS - what the patient reports (2)
    - Labour proper means regular painful contractions that are effacing and dilating the cervix
      [uterine contractions]
    - Ask when the contractions began and how far apart they are coming  [uterine contractions]
  SIGNS - what you find (4)
    - Abdominal examination gives the estimated fetal weight and the presentation
    - Vaginal examination assesses the shape and capacity of the bony pelvis alongside the cervix
    - Repeated examinations track position, station and descent - that is how normal progress is
      told from abnormal
    - The fetal heart trace may reassure, but it does not diagnose acidaemia
  TESTS (6)
    - On external monitoring aim for 3 to 5 contractions in a ten-minute window, each lasting 30 to
      40 seconds
    - Adequate activity is 200 to 250 Montevideo units
    - Montevideo units are the net contraction pressures added up across ten minutes
    - An intrauterine catheter measures true contraction strength, and is used once membranes have
      ruptured
    - An occiput posterior baby means a longer second stage and more caesareans
    - Turning the head manually shortens the second stage and beats repositioning the mother
  IF NOT THIS - what else fits (2)
    - Bandl ring, Braxton Hicks contractions, cervical stenosis or chorioamnionitis
    - Abruption, ruptured membranes, prodromal labour, a Mullerian anomaly, or a ruptured uterus
  Source  StatPearls "Abnormal Labor in Obstetrics: Recognition and Management" - disease-level
          clinical article
  Status  traced to the source above

1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)    [1st line]
   Adult    Cephalopelvic disproportion occurs when the fetal head is too large or the maternal
            pelvis too small to allow safe vaginal delivery. In primary care or antenatal clinic,
            suspect disproportion in primigravidae with unengaged fetal head at term, short maternal
            stature, or suspected fetal macrosomia. Refer promptly to an obstetric facility for
            pelvimetry, ultrasound fetal weight estimation, and planning of elective or emergency
            C-section to prevent obstructed labour. - Refer, with advice
   Peds     Adult-only condition - paediatric section not applicable
   Source   No dose - referral pathway, no medicine given in primary care
   Why      Cephalopelvic disproportion occurs when the fetal head is too large or the maternal
            pelvis too small to allow safe vaginal delivery. In primary care or antenatal clinic,
            suspect disproportion in primigravidae with unengaged fetal head at term, short maternal
            stature, or suspected fetal macrosomia. Refer promptly to an obstetric facility for
            pelvimetry, ultrasound fetal weight estimation, and planning of elective or emergency
            C-section to prevent obstructed labour.
   Caution  RED FLAG - Uterine rupture: assess urgently and refer.
            Suspected disproportion in active labour needs urgent obstetric management to avoid
            obstructed labour.
            No medicine is prescribed for this in primary care - this entry is for recognition and
            referral. Anything given is decided by the service it is referred to.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.
```

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