cephalopelvic disproportion

Episode-specific attribution

Record who used the term, for which pregnancy, and whether it denotes suspicion, a clinical conclusion or an inherited historical label.

1. Which pregnancy, fetus and labour episode does the disproportion attribution describe? boundary
2. Who applied the label, when, and what did they mean by it? provenance
3. Does the record describe a proposed anatomical mismatch, difficulty with the presenting head configuration, or an unspecified explanation for arrest? definition

Proposed site and mechanism

Capture the proposed level of constraint and contributions of head dimensions, position, attitude and pelvic anatomy without asserting an unobserved mechanism.

1. Is a constraint proposed at the pelvic inlet, midpelvis or outlet, and what observation supports that localisation? measurement
2. What head position, attitude and relevant pelvic findings were documented at the time of concern? measurement
3. Which contributing features were observed directly and which were inferred? provenance

Observed progress versus cause

Keep the description of protraction or arrest separate from its proposed cause, and identify the criteria used to assess progress. [ACOG First and Second Stage Labor Management](https://www.acog.org/clinical/clinical-guidance/clinical-practice-guideline/articles/2024/01/first-and-second-stage-labor-management).

1. What time-stamped changes in cervical dilation, head descent and rotation preceded the attribution? measurement
2. Which stage-specific criteria and guideline version were used to identify protraction or arrest? provenance
3. What evidence supports disproportion beyond the observation that progress stopped? boundary

Alternative cause assessment

Document assessment of uterine activity and fetal malposition alongside the disproportion hypothesis; labour abnormalities can have multiple contributors. [ACOG First and Second Stage Labor Management](https://www.acog.org/clinical/clinical-guidance/clinical-practice-guideline/articles/2024/01/first-and-second-stage-labor-management).

1. How was uterine activity assessed, and was its adequacy established or uncertain? measurement
2. Could malposition, deflexion or another documented cause explain the pattern independently of a persistent anatomical constraint? boundary
3. How did subsequent progress or response to clinician-directed measures change the causal assessment? measurement

Predictor limitations

Record predictor limitations explicitly. NICE advises against pelvimetry for deciding mode of birth and states that maternal height, shoe size and estimated fetal size do not accurately predict disproportion. [NICE Caesarean birth recommendations](https://www.nice.org.uk/guidance/ng192/chapter/recommendations).

1. Is the attribution based primarily on maternal height, shoe size, estimated fetal size or pelvimetry? provenance
2. What method, uncertainty and clinical interpretation accompany each recorded measurement? measurement
3. Does the proposed use of a measurement exceed what the cited guidance supports? boundary

Qualified diagnostic conclusion

Preserve supporting evidence, counterevidence and disagreement; do not promote an administrative diagnosis or delivery decision into independent proof of disproportion.

1. Which observations support the attribution, and which weaken it? provenance
2. Was the label drawn from a contemporaneous assessment, an operative report, a discharge code or a later recollection? provenance
3. What additional observation could cause the clinician to revise or withdraw the attribution? definition

Decision linked to evidence

Link the assessment to the responsible clinician's review, maternal and fetal condition, preferences, and documented rationale for the chosen course.

1. Which findings prompted obstetric review, and what urgency did the clinical team assign? action
2. Was the birth decision attributed to suspected obstruction, labour arrest, maternal or fetal compromise, or a combination? boundary
3. What rationale, alternatives and patient preferences were documented in the decision? action

Qualified carry-forward

Record delivery findings and unresolved causation so a future pregnancy assessment can distinguish persistent anatomy from circumstances specific to the previous labour.

1. What delivery or operative observations strengthened, weakened or failed to resolve the disproportion hypothesis? provenance
2. Which proposed contributors might persist, and which depended on that fetus or head position? boundary
3. How should the historical label and its uncertainty be presented for review in a subsequent pregnancy? action

Check these first

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these check these first hold for the sense of cephalopelvic disproportion this model covers, and on what evidence? provenance

Kinds and varieties

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these kinds and varieties hold for the sense of cephalopelvic disproportion this model covers, and on what evidence? provenance

Identifiers and schemes

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these identifiers and schemes hold for the sense of cephalopelvic disproportion this model covers, and on what evidence? provenance

Real-world use

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these real-world use hold for the sense of cephalopelvic disproportion this model covers, and on what evidence? provenance

Failure modes and hazards

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these failure modes and hazards hold for the sense of cephalopelvic disproportion this model covers, and on what evidence? provenance

Regional variation

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these regional variation hold for the sense of cephalopelvic disproportion this model covers, and on what evidence? provenance

Neighbouring kinds and how to tell them apart

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these neighbouring kinds and how to tell them apart hold for the sense of cephalopelvic disproportion this model covers, and on what evidence? provenance