Cephalopelvic disproportion (CPD) occurs when the birth canal is too small to allow the fetus to pass through due to factors like a small pelvis, abnormal pelvic shape, or large fetus. CPD can be caused by conditions like gestational diabetes, post-term pregnancy, or pelvic fractures. While ultrasound may estimate fetal size, it is often inaccurate so a trial of labor is usually recommended even if the fetus appears large. If CPD is diagnosed during active labor, caesarean section is usually required for delivery.