Cephalopelvic disproportion as primary diagnosis for cesarean section: Role of neonatal birthweight in relation to maternal height at a Hospital in Merida, Mexico

Méndez-Domínguez, Nina; Vazquez-Vazquez, Gumersindo Gaspar; Laviada-Molina, Hugo; Inurreta-Díaz, Martín; Fajardo-Ruiz, Lizbeth Sabrina; Azcorra, Hugo

doi:10.1002/ajhb.23463

Cited by 6 publications

(5 citation statements)

References 22 publications

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“…In turn, this nutritional burden can exacerbate the tight fetopelvic fit and has been proposed to explain elevated levels of obstructed labour, Caesarean sections, and infant mortality on the populational level (Wells, 2017 ; Wells et al ., 2018 ), but also in specific subgroups of various modern human populations, e.g. in Southeast Asian immigrants in the United States (Abitbol et al ., 1997 ) and in under‐resourced communities in Mexico (Mendez‐Dominguez et al ., 2021 ).…”

Section: Alternative and Complementary Views To The Obstetrical Dilemma Hypothesismentioning

confidence: 99%

The obstetrical dilemma hypothesis: there's life in the old dog yet

et al. 2021

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The term 'obstetrical dilemma' was coined by Washburn in 1960 to describe the trade-off between selection for a larger birth canal, permitting successful passage of a big-brained human neonate, and the smaller pelvic dimensions required for bipedal locomotion. His suggested solution to these antagonistic pressures was to give birth prematurely, explaining the unusual degree of neurological and physical immaturity, or secondary altriciality, observed in human infants. This proposed trade-off has traditionally been offered as the predominant evolutionary explanation for why human childbirth is so challenging, and inherently risky, compared to that of other primates. This perceived difficulty is likely due to the tight fit of fetal to maternal pelvic dimensions along with the convoluted shape of the birth canal and a comparatively low degree of ligamentous flexibility. Although the ideas combined under the obstetrical dilemma hypothesis originated almost a century ago, they have received renewed attention and empirical scrutiny in the last decade, with some researchers advocating complete rejection of the hypothesis and its assumptions. However, the hypothesis is complex because it presently captures several, mutually non-exclusive ideas: (i) there is an evolutionary trade-off resulting from opposing selection pressures on the pelvis; (ii) selection favouring a narrow pelvis specifically derives from bipedalism; (iii) human neonates are secondarily altricial because they are born relatively immature to ensure that they fit through the maternal bony pelvis; (iv) as a corollary to the asymmetric selection pressure for a spacious birth canal in females, humans evolved pronounced sexual dimorphism of pelvic shape. Recently, the hypothesis has been challenged on both empirical and theoretical grounds. Here, we appraise the original ideas captured under the 'obstetrical dilemma' and their subsequent evolution. We also evaluate complementary and alternative explanations for a tight fetopelvic fit and obstructed labour, including ecological factors related to nutrition and thermoregulation, constraints imposed by the stability of the pelvic floor or by maternal and fetal metabolism, the energetics of bipedalism, and variability in pelvic shape. This reveals that human childbirth is affected by a complex combination of evolutionary, ecological, and biocultural factors, which variably constrain maternal pelvic form and fetal growth. Our review demonstrates that it is unwarranted to reject the obstetrical dilemma hypothesis entirely because several of its fundamental assumptions have not been successfully discounted despite claims to the contrary. As such, the obstetrical dilemma remains a tenable hypothesis that can be used productively to guide evolutionary research.

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Section: Alternative and Complementary Views To The Obstetrical Dilemma Hypothesismentioning

confidence: 99%

The obstetrical dilemma hypothesis: there's life in the old dog yet

et al. 2021

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“…Heavier, large neonates have shown an increased risk for DDH (Lapunzina et al, 2002), this may be due to a mechanical process occurred at the end of pregnancy. Previous studies also reported propensity among women from Yucatan to deliver via cesarean section due to cephalopelvic disproportion, particularly when the ratio between birth weight and maternal height increased (Mendez‐Dominguez et al, 2021). This may explain, at least partially, the increased odds for cesarean section among women whose neonates had hip dysplasia, as their fetuses were also significantly heavier than non‐dysplasia neonates, even in absence of macrosomia.…”

Section: Discussionmentioning

confidence: 92%

“…Yucatan, located in southeast Mexico, concentrates mestizo population from Mayan ancestry, who preserve not only their phenotypic characteristics but also their cultural heritage and unfortunately, certain social inequities that limit the access to healthcare may influence the development of certain conditions (Azcorra & Mendez, 2018; Mendez‐Dominguez et al, 2021). But to our knowledge, the incidence of DDH in southeast Mexico among newborns has not yet been described, nor have their correlates explored.…”

Section: Introductionmentioning

confidence: 99%

Ethnic and sociodemographic correlates of developmental dysplasia of the hip in newborns from Yucatan, Mexico

Méndez-Domínguez

Álvarez-Baeza

Estrella-Castillo

et al. 2022

American J Hum Biol

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Objectives To provide an insight of the incidence of congenital developmental dysplasia of the hip in newborns from Yucatan born between 2015 and 2019 and analyze its association with maternal sociodemographic characteristics and neonatal, pregnancy and delivery related aspects. Methods Retrospective, population‐based study from Birth Registries database in Yucatan, Mexico between 2015 and 2019. Presence of hip dysplasia was described and analyzed considering three aspects (I) Maternal information (II) Pregnancy and birth (III) Neonatal examination. We obtained incidence rates from each year and the complete studied period. Association between hip dysplasia and maternal, neonatal and pregnancy/delivery variables was analyzed using logistic regression, unadjusted odds ratio and an adjusted model. Results Hip dysplasia occurred in 13 per 10 000 live births. Significant associations were found between hip dysplasia and maternal place of residence in a city <50 000 inhabitants, without a local clinic. Propensity to give birth to a neonate with hip dysplasia increased with maternal age and ethnicity, in female newborns and when total number of pregnancy consultations summed <5. Newborns with hip dysplasia were heavier and less susceptible to be delivered vaginally. Congenital developmental hip dysplasia was comparatively more frequent among offspring of Mayan women and suboptimal access to medical care during pregnancy. Female neonates were affected the most, those first‐borns. Neonates with hip dysplasia were heavier and more susceptible to be born by cesarean section. Conclusion Maternal, neonatal, and perinatal factors are associated with DDH in Yucatecan infants born during 2015–2019. Factors that describe living conditions seems to have a more important effect on the presence of this condition.

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“…However, others show moderate to high heterogeneity across studies and suggest issues of publication bias and residual confounding (Kuhle et al, 2015; Sutharsan et al, 2015). Confounders range from maternal/gestational characteristics that increase the risk of having a cesarean delivery (e.g., maternal advanced age, parity, previous cesareans, short stature, obesity, preexisting comorbidities, gestational diabetes, preeclampsia, fetal macrosomia and post‐maturity) (Campillo‐Artero et al, 2018; de Souza et al, 2019; Edelblute & Altman, 2021; Hure et al, 2017; Mendez‐Dominguez et al, 2021; Wells et al, 2018); type of cesarean delivery (e.g., pre/post labor, elective, planned for medical reasons, and emergency) (Cai et al, 2018; Chojnacki et al, 2019; Sitarik et al, 2020); and postnatal biological and behavioral factors that are associated with cesarean delivery (e.g., formula feeding, administration of antibiotics, altered cortisol profiles and gene expression) (Forbes et al, 2018; Kothiyal et al, 2020; Martinez et al, 2020; Rosenberg & Trevathan, 2018; Stinson et al, 2018; Tully & Ball, 2014).…”

Section: Discussionmentioning

confidence: 99%

Household conditions modulate associations between cesarean delivery and childhood growth

Veile

Kramer

Otárola‐Castillo

2022

American Journal of Biological Anthropology

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Introduction Cesarean delivery is associated with childhood obesity in urbanized and sanitized environments, but this is not well‐studied across broader epidemiologic settings. We examine birth mode, household conditions, and child growth in a Yucatec Maya farming community with limited sanitary infrastructure. We test the hypotheses that household infrastructure and epidemiologic conditions: (1) modulate associations between cesarean delivery and growth, and (2) are more strongly associated with growth compared to birth mode. Methods Birth mode, household characteristics (construction materials/waste disposal/water variables) and growth were examined in 106 children (0–5 years, 3554 longitudinal observations). A household modification index (HMI) was created to indicate “baseline” (more traditional) versus “modified” (more modernized) houses. Weight/height/BMI Z‐scores (WHO‐standards) were modeled with respect to HMI and birth mode using nested generalized linear mixed‐effects models. A series of interaction models were then compared. Results Four household modification variables (concrete roof and floor, latrine/septic tank, burning trash) were associated with greater growth gains and used to compose the HMI. Cesarean delivery was associated with slightly higher Z‐scores for most anthropometric outcomes. HMI modulated the association between birth mode and children's weight and height, but not BMI, trajectories. Weight and BMI Z‐scores, but not height Z‐scores, were higher at all ages under high HMI (“modified”) versus low HMI (“baseline”) conditions regardless of birth mode. Conclusions Understudied household conditions can modulate the association between cesarean delivery and childhood growth. These findings contribute to a large body of literature linking cesarean delivery to a variety of child health outcomes including obesity.

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Cephalopelvic disproportion as primary diagnosis for cesarean section: Role of neonatal birthweight in relation to maternal height at a Hospital in Merida, Mexico

Cited by 6 publications

References 22 publications

The obstetrical dilemma hypothesis: there's life in the old dog yet

The obstetrical dilemma hypothesis: there's life in the old dog yet

Ethnic and sociodemographic correlates of developmental dysplasia of the hip in newborns from Yucatan, Mexico

Household conditions modulate associations between cesarean delivery and childhood growth

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