Maternal height and external pelvimetry to predict cephalopelvic disproportion in nulliparous African women: a cohort study.
OBJECTIVE
To assess external pelvimetry and maternal height, as predictors of cephalopelvic disproportion.


METHODS
Prospective cohort study.


METHODS
Four hospitals in Zaire.


METHODS
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.


METHODS
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 x 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%.


CONCLUSIONS
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.
Liselele
H B
HB
Department of Gynaecology and Obstetrics, University of Kinshasa, Democratic Republic of Congo.
Boulvain
M
M
Tshibangu
K C
KC
Meuris
S
S
D000328:Adult; D001827:Body Height / Q000502:physiology*; D015331:Cohort Studies; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D005260:Female; D006801:Humans; D007744:Obstetric Labor Complications / Q000175:diagnosis; D016017:Odds Ratio; D010387:Pelvimetry / Q000379:methods; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity