{ "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-12T08:31:18Z", "providers": [ "Codex" ], "breadth": "recalled by Codex without web access - no source was read", "missingProviders": [], "pass": 2, "cost": { "grok": { "seconds": 22.2, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a094bc-f890-7581-b1ca-d1eec5994b91\n--------\nuser\nDescribe what is already known about one registered thing. Answer as JSON only, no prose around it.\n\nThing: cephalopelvic disproportion\nSense to describe: (none recorded)\nDomain code: XCT.STA\nAlso known as: (none)\n\n\nContext for this batch of 1001 things:\n# Bat", "usd": 0.0, "recall": true }, "codex": { "seconds": 72.0, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a094bc-f886-7662-a3e9-02513d2c0aff\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: cephalopelvic disproportion\nRegistry id: vr.tr.cephalopelvic-disproportion\nPlane / domain: XCT / XCT.STA\nRegistry definition: (none recorded)\nNames f" } }, "enrichment": { "pass": 3, "engine": "claude", "producedAt": "2026-10-06T12:00:00Z", "ingestedAt": "2026-10-06T08:42:16+00:00", "fields": [ "agent_conduct", "ethics", "failure_modes_and_hazards", "owners", "standards_and_regulation" ] }, "gate": { "passed": true, "version": "1.0", "at": "2026-10-07T10:10:29+00:00", "evidence": [ "completeness 1.00", "sense: Wikidata description", "2 live sources", "review by codex: pass" ] } }, "metaModel": { "id": "THING-Q3030582", "registryId": "vr.tr.cephalopelvic-disproportion", "name": "cephalopelvic disproportion", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "XCT.STA" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q3030582/", "model": { "registry_id": "vr.tr.cephalopelvic-disproportion", "name": "cephalopelvic disproportion", "purpose": "Enable an agent to represent suspected or clinically attributed cephalopelvic disproportion in a specific pregnancy, assess the supporting evidence, and identify decisions requiring obstetric review.", "definition": "Cephalopelvic disproportion is an obstetric condition in which the fetal head cannot pass through the maternal pelvis because their effective dimensions are incompatible during labour.", "scope_statement": "This model owns vr.tr.cephalopelvic-disproportion in XCT / XCT.STA: an actual or suspected mismatch between the fetal head and the maternal pelvic passage that impedes passage during birth, including the distinction between observed labour dysfunction and its attribution to disproportion.", "in_scope": [ "The fetal-head-maternal-pelvis relationship in a particular pregnancy and labour episode.", "Evidence supporting or weakening attribution of impaired passage to disproportion.", "Anatomical constraints and the contribution of head position, attitude and moulding.", "Diagnostic uncertainty, alternative explanations and reassessment over time.", "Consequences of the attribution for obstetric review and subsequent pregnancy records." ], "out_of_scope": [ "Comprehensive management of labour dystocia from all causes.", "Shoulder dystocia after delivery of the fetal head.", "Standalone models of fetal macrosomia, hydrocephalus or maternal pelvic deformity.", "Detailed protocols for labour augmentation, operative vaginal birth or caesarean birth.", "General fetal surveillance and maternal emergency management." ], "distinguishing_features": [ "The proposed obstruction concerns passage of the fetal head through the maternal pelvis; difficulty delivering the shoulders after the head belongs to shoulder dystocia.", "The entity is a relationship within a pregnancy, rather than a diagnosis established by fetal size or maternal pelvic size alone.", "Slow or arrested labour is an observation; disproportion is one possible explanation requiring a separate evidential assessment.", "The record must distinguish a proposed persistent anatomical constraint from a mismatch influenced by head position or attitude.", "A previous record of disproportion is historical evidence whose relevance must be reassessed for the current fetus and labour." ], "characteristics": [ { "name": "Pregnancy and labour episode", "kind": "relation", "unit_or_values": "Links to pregnant person, fetus, pregnancy and labour episode", "why_it_matters": "Prevents a pregnancy-specific attribution from becoming an unqualified permanent maternal characteristic." }, { "name": "Attribution status", "kind": "state", "unit_or_values": "Suspected; clinically attributed; disputed; withdrawn; historical with unclear evidence", "why_it_matters": "Separates diagnostic judgement from directly observed anatomy or labour progress." }, { "name": "Proposed mechanical basis", "kind": "category", "unit_or_values": "Pelvic constraint; fetal head dimensions; head position or attitude contribution; combined; undetermined", "why_it_matters": "Makes the hypothesised cause explicit without treating different mechanisms as interchangeable." }, { "name": "Head-pelvis observations", "kind": "measurement", "unit_or_values": "Named head or pelvic dimensions in mm where available, with method, timing and uncertainty", "why_it_matters": "Preserves measurements without inventing a universal numerical threshold for disproportion." }, { "name": "Head configuration", "kind": "category", "unit_or_values": "Presentation, position, flexion or deflexion, asynclitism, and recorded moulding assessment", "why_it_matters": "Describes how the head is attempting to traverse the pelvis." }, { "name": "Labour progress trajectory", "kind": "measurement", "unit_or_values": "Time-stamped cervical dilation in cm, station using a named scale, and rotation observations", "why_it_matters": "Allows review of the sequence underlying an obstruction hypothesis." }, { "name": "Uterine activity assessment", "kind": "measurement", "unit_or_values": "Contractions per 10 minutes, duration in seconds, and adequacy assessment with its measurement method", "why_it_matters": "Records whether insufficient propulsive activity remains an alternative explanation." }, { "name": "Diagnostic evidence provenance", "kind": "relation", "unit_or_values": "Linked examinations, imaging reports, labour records, clinician assessments and applicable guidance", "why_it_matters": "Makes the attribution auditable and preserves disagreement between observers." } ], "affordances": [ "Assemble a time-ordered evidence record for a suspected head-pelvis mismatch.", "Separate observed labour arrest from the clinician's explanation for it.", "Flag reliance on unsupported predictors or missing evidence.", "Compare successive assessments to show whether the attribution strengthens, weakens or remains unresolved.", "Prepare an obstetric review summary connecting the suspected mechanism, current condition and recorded decision rationale.", "Carry forward a qualified account of the previous episode for review in another pregnancy." ], "agent_conduct": { "may": [ "Explain the condition in general terms from reputable obstetric sources.", "Help a pregnant person prepare questions about birth options for their midwife or doctor." ], "must_not": [ "Predict for a specific person that labour will fail or a caesarean will be needed.", "Advise on delivery mode for a specific pregnancy.", "Pressure anyone toward or away from caesarean birth.", "Disclose a person's obstetric records without consent." ], "requires_human": [ "Any decision on delivery method, which belongs to the woman and her care team." ] }, "ethics": { "considerations": [ "Obstructed labour without access to care still kills mothers and babies in many places.", "Birth decisions concern bodily autonomy and must not be made over the woman." ], "affected_parties": [ "Women in labour", "Newborns", "Families" ] }, "owners": { "steward": "Nobody owns the condition; the woman and her obstetric team answer for care.", "master_systems": [] }, "failure_modes_and_hazards": [ "Obstructed labour can lead to uterine rupture, fistula and death of mother or baby.", "Over-diagnosis can lead to unnecessary caesarean sections." ], "standards_and_regulation": [ "WHO recommendations: intrapartum care for a positive childbirth experience, World Health Organization." ], "what_it_is_for": [ "Cephalopelvic disproportion is considered in obstetric assessment when the relationship between the fetal head and maternal pelvis may impede vaginal birth.", "It appears in maternity records and clinical discussions of labour progress, with suspected and clinically attributed cases requiring clear distinction." ], "facets_not_applicable": { "recognition": "Cephalopelvic disproportion is a clinical condition without a distinctive visible appearance and cannot be identified reliably from external visual cues." } }, "sources": [ { "id": "wikidata", "title": "Wikidata item Q3030582: cephalopelvic disproportion", "url": "https://www.wikidata.org/wiki/Q3030582", "url_status": "live", "what_it_supports": "identity and sense of the item", "checked_by": "wikidata-api" }, { "id": "wikipedia-en", "title": "Wikipedia: Cephalopelvic disproportion", "url": "https://en.wikipedia.org/wiki/Cephalopelvic_disproportion", "url_status": "live", "what_it_supports": "general description of the item", "checked_by": "wikidata-api sitelink" } ], "structure": { "bundles": [ { "id": "head-pelvis-relationship", "name": "Head-pelvis relationship", "description": "Represent the specific relationship whose adequacy for head passage is in question.", "rationale": "Disproportion cannot be adequately represented as fetal size or maternal anatomy in isolation.", "layers": [ { "id": "episode-and-meaning", "name": "Episode and meaning", "description": "Anchor the label to a pregnancy and an explicit interpretation.", "findings": [ { "id": "episode-specific-attribution", "name": "Episode-specific attribution", "description": "Record who used the term, for which pregnancy, and whether it denotes suspicion, a clinical conclusion or an inherited historical label.", "questions": [ { "text": "Which pregnancy, fetus and labour episode does the disproportion attribution describe?", "kind": "boundary", "id": "episode-specific-attribution-q01" }, { "text": "Who applied the label, when, and what did they mean by it?", "kind": "provenance", "id": "episode-specific-attribution-q02" }, { "text": "Does the record describe a proposed anatomical mismatch, difficulty with the presenting head configuration, or an unspecified explanation for arrest?", "kind": "definition", "id": "episode-specific-attribution-q03" } ] } ] }, { "id": "mechanical-contributors", "name": "Mechanical contributors", "description": "Describe the pelvic passage and the head configuration implicated in impaired passage.", "findings": [ { "id": "proposed-site-and-mechanism", "name": "Proposed site and mechanism", "description": "Capture the proposed level of constraint and contributions of head dimensions, position, attitude and pelvic anatomy without asserting an unobserved mechanism.", "questions": [ { "text": "Is a constraint proposed at the pelvic inlet, midpelvis or outlet, and what observation supports that localisation?", "kind": "measurement", "id": "proposed-site-and-mechanism-q01" }, { "text": "What head position, attitude and relevant pelvic findings were documented at the time of concern?", "kind": "measurement", "id": "proposed-site-and-mechanism-q02" }, { "text": "Which contributing features were observed directly and which were inferred?", "kind": "provenance", "id": "proposed-site-and-mechanism-q03" } ] } ] } ] }, { "id": "labour-evidence-and-alternatives", "name": "Labour evidence and alternatives", "description": "Assess the labour pattern and competing explanations underlying the attribution.", "rationale": "A record of slow progress must not silently become proof of a mechanical mismatch.", "layers": [ { "id": "progress-over-time", "name": "Progress over time", "description": "Preserve the observations used to identify impaired progress.", "findings": [ { "id": "observed-progress-versus-cause", "name": "Observed progress versus cause", "description": "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).", "questions": [ { "text": "What time-stamped changes in cervical dilation, head descent and rotation preceded the attribution?", "kind": "measurement", "id": "observed-progress-versus-cause-q01" }, { "text": "Which stage-specific criteria and guideline version were used to identify protraction or arrest?", "kind": "provenance", "id": "observed-progress-versus-cause-q02" }, { "text": "What evidence supports disproportion beyond the observation that progress stopped?", "kind": "boundary", "id": "observed-progress-versus-cause-q03" } ] } ] }, { "id": "competing-mechanisms", "name": "Competing mechanisms", "description": "Record alternative or coexisting explanations for impaired progress.", "findings": [ { "id": "alternative-cause-assessment", "name": "Alternative cause assessment", "description": "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).", "questions": [ { "text": "How was uterine activity assessed, and was its adequacy established or uncertain?", "kind": "measurement", "id": "alternative-cause-assessment-q01" }, { "text": "Could malposition, deflexion or another documented cause explain the pattern independently of a persistent anatomical constraint?", "kind": "boundary", "id": "alternative-cause-assessment-q02" }, { "text": "How did subsequent progress or response to clinician-directed measures change the causal assessment?", "kind": "measurement", "id": "alternative-cause-assessment-q03" } ] } ] } ] }, { "id": "assessment-limits-and-confidence", "name": "Assessment limits and confidence", "description": "Track what observations can establish and where the diagnostic inference remains uncertain.", "rationale": "The model needs safeguards against treating predictors, measurements or repeated labels as definitive evidence.", "layers": [ { "id": "prediction-and-measurement", "name": "Prediction and measurement", "description": "Distinguish anatomical observations from validated prediction of passage.", "findings": [ { "id": "predictor-limitations", "name": "Predictor limitations", "description": "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).", "questions": [ { "text": "Is the attribution based primarily on maternal height, shoe size, estimated fetal size or pelvimetry?", "kind": "provenance", "id": "predictor-limitations-q01" }, { "text": "What method, uncertainty and clinical interpretation accompany each recorded measurement?", "kind": "measurement", "id": "predictor-limitations-q02" }, { "text": "Does the proposed use of a measurement exceed what the cited guidance supports?", "kind": "boundary", "id": "predictor-limitations-q03" } ] } ] }, { "id": "diagnostic-confidence", "name": "Diagnostic confidence", "description": "Represent confidence as a revisable clinical judgement with explicit support.", "findings": [ { "id": "qualified-diagnostic-conclusion", "name": "Qualified diagnostic conclusion", "description": "Preserve supporting evidence, counterevidence and disagreement; do not promote an administrative diagnosis or delivery decision into independent proof of disproportion.", "questions": [ { "text": "Which observations support the attribution, and which weaken it?", "kind": "provenance", "id": "qualified-diagnostic-conclusion-q01" }, { "text": "Was the label drawn from a contemporaneous assessment, an operative report, a discharge code or a later recollection?", "kind": "provenance", "id": "qualified-diagnostic-conclusion-q02" }, { "text": "What additional observation could cause the clinician to revise or withdraw the attribution?", "kind": "definition", "id": "qualified-diagnostic-conclusion-q03" } ] } ] } ] }, { "id": "decision-context-and-follow-through", "name": "Decision context and follow-through", "description": "Connect the disproportion assessment to clinical decisions and its interpretation after the episode.", "rationale": "The label affects birth decisions and future records, so its consequences and evidential limits must remain visible.", "layers": [ { "id": "obstetric-review", "name": "Obstetric review", "description": "Record the decision context without turning the model into a treatment protocol.", "findings": [ { "id": "decision-linked-to-evidence", "name": "Decision linked to evidence", "description": "Link the assessment to the responsible clinician's review, maternal and fetal condition, preferences, and documented rationale for the chosen course.", "questions": [ { "text": "Which findings prompted obstetric review, and what urgency did the clinical team assign?", "kind": "action", "id": "decision-linked-to-evidence-q01" }, { "text": "Was the birth decision attributed to suspected obstruction, labour arrest, maternal or fetal compromise, or a combination?", "kind": "boundary", "id": "decision-linked-to-evidence-q02" }, { "text": "What rationale, alternatives and patient preferences were documented in the decision?", "kind": "action", "id": "decision-linked-to-evidence-q03" } ] } ] }, { "id": "outcome-and-future-interpretation", "name": "Outcome and future interpretation", "description": "Reassess the attribution after birth and preserve its episode-specific meaning.", "findings": [ { "id": "qualified-carry-forward", "name": "Qualified carry-forward", "description": "Record delivery findings and unresolved causation so a future pregnancy assessment can distinguish persistent anatomy from circumstances specific to the previous labour.", "questions": [ { "text": "What delivery or operative observations strengthened, weakened or failed to resolve the disproportion hypothesis?", "kind": "provenance", "id": "qualified-carry-forward-q01" }, { "text": "Which proposed contributors might persist, and which depended on that fetus or head position?", "kind": "boundary", "id": "qualified-carry-forward-q02" }, { "text": "How should the historical label and its uncertainty be presented for review in a subsequent pregnancy?", "kind": "action", "id": "qualified-carry-forward-q03" } ] } ] } ] }, { "id": "evidence-and-external-alignment", "name": "Evidence and external alignment", "description": "What the world already says about this thing, gathered so the model can be checked against it.", "rationale": "A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.", "layers": [ { "id": "reported-evidence", "name": "Reported evidence", "description": "Findings from the breadth pass, kept separate from the structural claims.", "findings": [ { "id": "evidence-confidence-notes", "name": "Check these first", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "This is recall-based information; no sources were consulted.", "Absolute and relative disproportion are traditional distinctions whose definitions and clinical application vary.", "No single universal pelvic dimension or fetal weight threshold establishes disproportion; verify diagnostic criteria and jurisdiction-specific coding before operational use." ], "questions": [ { "id": "evidence-confidence-notes-q01", "text": "Which of these check these first hold for the sense of cephalopelvic disproportion this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-kinds", "name": "Kinds and varieties", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Absolute disproportion, reflecting a fixed mechanical incompatibility", "Relative disproportion, in which fetal head position, attitude or moulding influences whether passage is possible" ], "questions": [ { "id": "evidence-kinds-q01", "text": "Which of these kinds and varieties hold for the sense of cephalopelvic disproportion this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-identifiers", "name": "Identifiers and schemes", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "scheme": "ICD-10", "value_or_pattern": "O33", "note": "WHO category for maternal care for known or suspected disproportion; this is broader than confirmed cephalopelvic disproportion, and coding differs when obstructed labour is established." } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of cephalopelvic disproportion this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-real-world-use", "name": "Real-world use", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "A diagnostic consideration when cervical dilatation or fetal descent fails to progress during labour", "An indication for caesarean delivery when mechanical obstruction is established", "A consideration in reviewing the cause of a previous caesarean and planning subsequent childbirth" ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of cephalopelvic disproportion this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-failure-modes-and-hazards", "name": "Failure modes and hazards", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Unresolved mechanical obstruction can cause prolonged or obstructed labour, with maternal injury and fetal compromise.", "Severe or neglected obstruction can lead to uterine rupture, obstetric fistula or perinatal death.", "Diagnosing disproportion from slow progress alone can overlook inadequate contractions or fetal malposition.", "Treating maternal stature, estimated fetal weight or pelvimetry as a definitive predictor can produce incorrect diagnoses and unnecessary intervention." ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of cephalopelvic disproportion this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-regional-variation", "name": "Regional variation", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Access to labour monitoring and timely operative delivery strongly affects the consequences of obstructed labour.", "Diagnostic terminology, coding practices and use of pelvimetry vary between health systems." ], "questions": [ { "id": "evidence-regional-variation-q01", "text": "Which of these regional variation hold for the sense of cephalopelvic disproportion this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-neighbours", "name": "Neighbouring kinds and how to tell them apart", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "name": "Obstructed labour", "difference": "Obstructed labour is the clinical failure of passage caused by a mechanical barrier; cephalopelvic disproportion is one possible cause." }, { "name": "Labour dystocia", "difference": "Dystocia includes slow or difficult labour from multiple causes and does not by itself establish a mismatch between head and pelvis." }, { "name": "Fetal macrosomia", "difference": "Macrosomia describes a large fetus; disproportion describes incompatibility with a particular maternal pelvis and can occur without macrosomia." }, { "name": "Fetal malposition", "difference": "Malposition concerns fetal orientation and can impede descent without a fixed size mismatch, although it may contribute to relative disproportion." }, { "name": "Contracted pelvis", "difference": "A contracted pelvis is an anatomical finding; cephalopelvic disproportion depends on the relationship between the pelvis and the presenting fetal head." } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "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?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "Which operational definition best separates anatomical disproportion from position-dependent difficulty across the clinical sources selected for publication?", "What evidence, if any, justifies describing an individual episode as confirmed rather than clinically attributed disproportion?", "How reproducibly can clinicians localise the proposed constraint and distinguish it from malposition using examination or intrapartum imaging?", "How should a previous disproportion attribution influence assessment in a later pregnancy when the original labour evidence is incomplete?", "Which terminology and evidence requirements vary by jurisdiction, and how should the model preserve those differences without implying a universal diagnostic threshold?" ], "statistics": { "bundles": 5, "layers": 9, "findings": 15, "questions": 31 } }