Cephalopelvic disproportion exists when the capacity of the pelvis is inadequate to allow the fetus to negotiate the birth canal. This may be due to a small pelvis, a nongynecoid pelvic formation, a large fetus, an unfavorable orientation of the fetus, or a combination of these factors. Certain medical conditions may distort pelvic bones, such as rickets or a pelvic fracture, and lead to CPD. Transverse diagonal measurement has been proposed as a predictive method. Causes
A large fetus can be one cause of CPD. A large fetus can be caused by gestational diabetes, postterm pregnancy, genetic factors, and multiparity. The shape of the pelvis can also be a cause of CPD. The pelvis may be too small, or the shape of the pelvis may be malformed. Shorter women are more likely to have CPD as are adolescents. Diagnosis
Diagnosis of CPD may be made when there is failure to progress, but not all cases of prolonged labour are the result of CPD. Use of ultrasound to measure the size of the fetus in the womb is controversial, as these methods are often inaccurate and may lead to unnecessary caesarian section; a trial of labour is often recommended even if size of the fetus is estimated to be large.Theoretically, pelvimetry may identify cephalo-pelvic disproportion. However, a womans pelvis loosens up before birth (with the help of hormones). A Cochrane review in 2017 found that there was too little evidence to show whether pelvimetry is beneficial and safe when the baby is in cephalic presentation.
The International Nonproprietary Name Dronabinol, also known as delta-9-tetrahydrocannabinol, or under the trade names Marinol, Syndros, Reduvo and Adversa, is a generic name for the molecule of delta-9-tetrahydrocannabinol in the pharmaceutical context. It has indications as an appetite stimulant, antiemetic, and sleep apnea reliever and is approved by the FDA as safe and effective for HIV/AIDS-induced anorexia and chemotherapy-induced nausea and vomiting only.Dronabinol is the principal psychoactive constituent enantiomer form, (−)-trans-Δ9-tetrahydrocannabinol, found in cannabis. Dronabinol does not include any other tetrahydrocannabinol (THC) isomers or any cannabidiol. Medical uses
Appetite stimulant and anti-emetic
Dronabinol is used to stimulate appetite and therefore weight gain in patients with HIV/AIDS and cancer. It is also used to treat chemotherapy-induced nausea and vomiting. Analgesic
Dronabinol demonstrated analgesic efficacy in a majority of studies in chronic pain, the data in acute pain is less conclusive. Cannabis addiction
Dronabinol may be useful in treating cannabis addiction as it has been shown to reduce cannabis withdrawal symptoms and the subjective effects of marijuana. Sleep apnea
Dronabinol demonstrates significant improvement in sleep apnea scores. Phase 2B clinical trials were completed in 2017 for FDA approval for this indication. Overdose
A mild overdose of dronabinol presents drowsiness, dry-mouth, euphoria, and tachycardia; whereas a severe overdose presents lethargy, slurred speech, decreased motor coordination, and postural hypotension.