Maternal height and external pelvimetry to predict cephalopelvic disproportion in nulliparous African women: a cohort study

Abstract

Objective To assess external pelvimetry and maternal height, as predictors of cephalopelvic disproportion.Design Prospective cohort study.Setting Four hospitals in Zaire.Population Six hundred and five nulliparous women.Methods Maternal height and external pelvimetry were assessed during the third trimester antenatal visit. Cut off values for considering women at risk for cephalopelvic disproportion were height < 150 cm and external pelvic distances < 10th centile for the population. Logistic regression analysis, combining height and pelvic measurements, was performed to predict women at risk for cephalopelvic disproportion.Main outcome measure Cephalopelvic disproportion was considered when there was caesarean section for failure to progress, vacuum or forceps delivery or intrapartum stillbirth.Results Cephalopelvic disproportion was present in 42 women. In univariate analysis, height, intertrochanteric diameter and the transverse diagonal of Michaelis sacral rhomboid area were found to be associated with cephalopelvic disproportion. Logistic regression analysis showed that maternal height < 150 cm and/or transverse diagonal < 9.5 cm were the variables most associated with cephalopelvic disproportion. The adjusted odds ratios were 2.2 (95% CI 0.9 to 5.4) and 6.5 (95% CI 3.2 to 13.2), respectively. The positive predictive value and likelihood ratio were 24% and 4.0 (95% CI 2-8 to 5-8), respectively. The addition of transverse diagonal to maternal height increased the sensitivity in predicting cephalopelvic disproportion from 21% to 52% .Conclusion In addition to height, transverse diagonal measurement is able to predict one out of two cases of cephalopelvic disproportion in nulliparous women. After validation in a separate cohort, this simple predictive method may be used in peripheral centres for timely referral of pregnant women at risk for cephalopelvic disproportion.

Maternal and perinatal outcomes among nulliparous adolescents in low‐ and middle‐income countries: a multi‐country study

“…Gestational age at birth was defined as the number of completed weeks of gestation based on the estimated delivery date in the clinical records. Consistent with previous studies, 13,14 the operational definition of caesarean section indicated for cephalopelvic disproportion (CPD) in our study was based on presumed CPD, and included caesarean sections indicated for dystocia, failure to progress, and failed vacuum extraction or forceps delivery, but excluded those indicated for fetal distress, breech and other types of malpresentation, and failed induction. Maternal and early neonatal deaths were defined as intra-hospital deaths that occurred on or before the eighth day postpartum and seventh day after delivery, respectively.…”

Risk Factors for Cesarean Delivery after Induction of Labor in Nulliparous Women with an Unfavorable Cervix at or beyond 41 Weeks of Gestation

“…Short maternal height was previously reported as a risk factor for CS and shoulder dystocia, likely due to cephalopelvic disproportion (CPD) [27,28,29]. In addition, a large BPD of the newborn was associated with CPD [30].…”

Risk factors and perinatal outcome of pregnancies complicated with cephalopelvic disproportion: a population-based study

“…Attempts to predict which maternal pelvis bares the tendency for CPD and dystocia have been made [2][3][4], suggesting nulliparity [2,3,5], fetal macrosomia, epidural analgesia [6], hydramnios, hypertensive disorders and gestational diabetes mellitus [2,[7][8][9][10][11][12] as risk factors for second stage of labor arrest. Measurement of the intertrochanteric distance and transverse diagonal of Michaelis sacral rhomboid area have been suggested as screening procedure in remote areas [13,14]. Clinical pelvimetry is a fading skill, and X-ray pelvimetry was not proven eVective in predicting CPD and is not recommended for ruling out dystocia due to CPD [1,[15][16][17].…”