Cephalopelvic disproportion (CPD) secondary to narrow maternal pelvis continues to pose a substantial challenge in modern obstetrics, often leading to obstructed labor, increased cesarean section rates, maternal morbidity, and neonatal complications. This expanded review comprehensively examines the etiological factors, including evolutionary constraints on pelvic morphology, diagnostic modalities such as advanced imaging and intrapartum assessments, evidence-based management protocols ranging from expectant approaches to surgical interventions, and a detailed analysis of potential complications like fetal distress and postpartum hemorrhage. Drawing on high-quality scientific evidence from recent epidemiological studies, meta-analyses, and clinical trials, we highlight the multifactorial nature of CPD, with incidence estimates ranging from 1-5% in diverse populations, influenced by maternal anthropometrics, fetal macrosomia, and pelvic variants such as android or platypelloid shapes. The topic's timeliness is evident in the context of global rising cesarean deliveries, now exceeding 21% worldwide, partly attributable to CPD, underscoring the need for predictive algorithms and preventive strategies. High innovative potential is identified in integrating artificial intelligence for pelvimetric analysis, personalized risk stratification, and simulation-based training to optimize outcomes. This article extends prior syntheses by incorporating longitudinal data, cross-cultural comparisons, and emerging biomechanical models, providing an in-depth resource for obstetricians, midwives, and researchers to advance evidence-informed care and mitigate disparities in maternal-fetal health.

cephalopelvic disproportion, narrow pelvis, obstructed labor, pelvimetry, cesarean section, fetal macrosomia, dystocia, labor progression, maternal pelvis types, birth complications, evolutionary obstetrics, diagnostic imaging

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