Association between external pelvimetry and vertex delivery complications in African women

Objective. To assess association between external pelvimetry and delivery complications in vertex presentation. Methods. Prospective cohort study of 2413 pregnant women antenatally measured for height and external pelvimetry in four hospitals of the former Republic of Zaire. Outcome measures: Complications during delivery of single fetus weighing 2000 g or more in vertex presentation. Cut-off values at risk for delivery complications were height and pelvic distances closest to the study population 10th percentile. Results. In univariate analysis, maternal height showed significant relative risk for predicting primary cesarean section for failure to progress: 2.0 (95% CI = 1.0-4.1; p = 0.050) and vacuum or forceps delivery: 15.7 (95% CI = 6.6-37.5; p < 0.001). Selected external pelvic distances showed significant relative risks for predicting the following complications: primary cesarean section for failure to progress, elective repeat cesarean section, vacuum or forceps delivery and spontaneous intrapartum stillbirth. Among pelvic predictors, transverse diagonal (TD) of Michaelis sacral rhomboid area was associated with all of these complications. Intertrochanteric (IT) diameter was associated with three of them. The relative risks ranged from 2.3 (95% CI = 1.1-6.3; p = 0.030) to 9.6 (95% CI = 4.1-22.5: p < 0.001) for these strongest predictors. Conclusions. External pelvic distances help to predict vertex delivery complications in African women. The predicted complications are compatible with the cephalopelvic disproportion concept (CPD). After validation of current results in a separate cohort, measurements of IT and/or TD are recommended to improve antenatal screening of women at risk for CPD in limited resources settings.SCOPUS: ar.jFLWINinfo:eu-repo/semantics/publishe

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

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

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

ObjectiveTo investigate the risk of adverse pregnancy outcomes and caesarean section among adolescents in low- and middle-income countries.DesignSecondary analysis using facility-based cross-sectional data from the World Health Organization (WHO) Global Survey on Maternal and Perinatal Health.SettingTwenty-three countries in Africa, Latin America, and Asia.PopulationWomen admitted for delivery in 363 health facilities during 2-3months between 2004 and 2008.MethodsWe constructed multilevel logistic regression models to estimate the effect of young maternal age on risks of adverse pregnancy outcomes.Main outcome measuresRisk of adverse pregnancy outcomes among young mothers.ResultsA total of 78646 nulliparous mothers aged 24years and their singleton infants were included in the analysis. Compared with mothers aged 20-24years, adolescents aged 16-19years had a significantly lower risk of caesarean section (adjusted OR 0.75, 95% CI 0.71-0.79). When the analysis was restricted to caesarean section indicated for presumed cephalopelvic disproportion, the risk of caesarean section was significantly higher among mothers aged 15years (aOR 1.27, 95% CI 1.07-1.49) than among those aged 20-24years. Higher risks of low birthweight and preterm birth were found among adolescents aged 16-19years (aOR 1.10, 95% CI 1.03-1.17; aOR 1.16, 95% CI 1.09-1.23, respectively) and 15years (aOR 1.33, 95% CI 1.14-1.54; aOR 1.56, 95% CI 1.35-1.80, respectively).ConclusionsAdolescent girls experiencing pregnancy at a very young age (i.e. <16years) have an increased risk of adverse pregnancy outcomes.UNDP/UNFPA/WHO/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP)Department of Reproductive Health and Research (RHR)Ministry of Health, Labour and Welfare of JapanUnited States Agency for International Development (USAID)Ministry of Public Health, Beijing, ChinaIndian Council of Medical Research, Delhi, IndiaUniv Tokyo, Grad Sch Med, Dept Global Hlth Policy, Tokyo 1130033, JapanNatl Ctr Child Hlth & Dev, Dept Hlth Policy, Tokyo, JapanUniversidade Federal de São Paulo, Dept Obstet, São Paulo, BrazilWHO, Dept Reprod Hlth & Res, CH-1211 Geneva, SwitzerlandUniv Western Australia, Sch Populat Hlth, Perth, WA 6009, AustraliaUniversidade Federal de São Paulo, Dept Obstet, São Paulo, BrazilMinistry of Health, Labour and Welfare of Japan: 09151353Web of Scienc