Kakoma Jean-Baptiste
University of Lubumbashi Faculty of Medicine and School of Public Health, Lubumbashi, Democratic Republic of the Congo; University of Rwanda, College of Medicine and Health Sciences, Schools of Medicine and Public Health, Kigali, Rwanda.
Pan Afr Med J. 2016 Aug 12;24:310. doi: 10.11604/pamj.2016.24.310.9603. eCollection 2016.
Maternal anthropometric parameters as risk factors for cesarean section have always been a matter of interest and concern for obstetricians. Some of these parameters have been shown to be predictors of dystocia. This study aims at showing the relationship between cesarean section indications and anthropometric parameters sizes in Rwandan nulliparae for the purpose of comparison and appropriate recommendations.
A cross-sectional and analytical study was made on data collected from 32 operated patients among 152 nulliparae with singleton pregnancy at term and vertex presentation. Concerned anthropometric parameters were height, weight and six pelvic distances. Fisher exact and Student's tests were used to compare observed proportions and mean values, respectively.
Findings were as follows: 1) the overall cesarean section rate was 21.05%; 2) acute fetal distress (31.3 %), generally contracted pelvis (28.1 %), and engagement failure (25%) were the most frequent indications of cesarean section; 3) all patients ≤ 145 cm tall were operated on for general pelvis contraction whose proportion was significantly higher in them than in the others (p < 0.01); 4) more than half of pelvis contraction cases were observed in patients weighing ≤ 50 kg, but the difference with other weight categories was not significant; 5) considered external pelvic diameters but the Biiliac Diameter displayed average measurements smaller in clinically contracted pelvis than in other CS indications.
External pelvimetry associated with specific other anthropometric parameters could be helpful in the screening of generally contracted pelves, and consequently pregnancies at high risk of cephalopelvic disproportion in nulliparous women, particularly in developing countries with limited resources. Further investigations are requested to deal with this topic in depth.
产妇人体测量参数作为剖宫产的风险因素一直是产科医生关注的焦点。其中一些参数已被证明是难产的预测指标。本研究旨在揭示卢旺达初产妇剖宫产指征与人体测量参数大小之间的关系，以便进行比较并提出适当建议。
对152名单胎足月妊娠且为头先露的初产妇中的32例手术患者收集的数据进行横断面分析研究。相关人体测量参数包括身高、体重和六个骨盆径线。分别使用Fisher精确检验和学生检验来比较观察到的比例和平均值。
研究结果如下：1）总体剖宫产率为21.05%；2）急性胎儿窘迫（31.3%）、骨盆普遍狭窄（28.1%）和入盆失败（25%）是最常见的剖宫产指征；3）所有身高≤145 cm的患者均因骨盆普遍狭窄接受手术，其比例显著高于其他患者（p<0.01）；4）超过一半的骨盆狭窄病例见于体重≤50 kg的患者，但与其他体重类别之间的差异不显著；5）考虑外部骨盆直径时，双侧髂嵴间径在临床骨盆狭窄患者中的平均测量值小于其他剖宫产指征患者。
结合特定其他人体测量参数的外测量骨盆法有助于筛查骨盆普遍狭窄情况，进而筛查初产妇中头盆不称高危妊娠，特别是在资源有限的发展中国家。需要进一步深入研究该主题。
