Childbirth on a Moderately Shrinked Pelvis at the Institut D hygiene Sociale Hospital in Dakar

Research Article

Austin J Obstet Gynecol. 2023; 10(2): 1219.

Childbirth on a Moderately Shrinked Pelvis at the Institut D’hygiene Sociale Hospital in Dakar

Niang MM*; Wade AM; Samb F; Cisse CT

Department of Gynecology & Obstetrics, Institute of Social Hygiene Hospital of Dakar, Senegal

*Corresponding author: Mouhamadou Mansour Naing Associate Professor, Cheikh Anta Diop University of Dakar, Senegal. Tel: (221) 77-656-63-43 Email: mansniang@hotmail.com

Received: June 08, 2023 Accepted: July 08, 2023 Published: July 15, 2023

Summary

Objectives: To assess the frequency of moderately narrowed pelvises, to specify the epidemiological and clinical profile of parturients, the mode of childbirth and to evaluate the maternal and neonatal prognosis in patients who underwent a trial of labour at the IHS hospital between the January 1st, 2019 and December 31st, 2020.

Patients and Methods: This was a descriptive and analytical retrospective study of all patients who underwent a trial of labour at the Gynaecology-Obstetrics Department of the IHS Hospital in Dakar between January 1st and December 31st, 2020, i.e. a period of 12 months. Data were collected from birth records. Data entry was performed with EPI INFO 7 software and analysis with SPSS 21 software.

Results: During the study period, we performed 101 labour trials among the 2156 childbirths, a frequency of 4.6% of childbirths. The epidemiological profile of the patients was that of a primiparous woman (73.3%) with an average age of 24, married (96.9%), having carried out at least 3 prenatal consultations (90%) and carrying a pregnancy at term (97%). Clinically, the average fundal height was 33 cm with extremes of 27 and 40 cm. The majority of patients (73.3%) had a borderline pelvis while the transversely narrowed pelvis accounted for only 26.7% of cases. The introductory palpation was only performed in 17 patients (16.8%) and it was doubtful in 11 of them (10.9%). The trial of labour ended in vaginal childbirth in 34.7% of cases or in caesarean section in 65.3% of patients. Failure of the trial of labour was more frequent in nulliparous (76.9%) compared to primiparous (64.9%), pauciparous (72.7%) (p=0.082) and in patients with borderline pelvis (79.5%) compared to those who had a transversely narrowed pelvis (68.7%) (p=0.392). In our series, 12 new-borns (11.9%) had benefited from neonatal resuscitation and eleven of them, that is a rate of 10.8%, were transferred to a neonatology unit. These were cases of non-reassuring fetal status occurring during the expulsive phase. Their evolution was favourable in all cases. One early neonatal death (1%) was recorded. No maternal complication had been notified.

Conclusion: Childbirths on a moderately narrowed pelvis are not uncommon in our practice. They require a prior clinical evaluation of the parturients, particularly with the introducer palpation in order to increase the chances of a favourable outcome and to avoid maternal and perinatal complications.

Keywords: Trial of labour; Moderately constricted pelvis; Caesarean section

Introduction

Maternal and neonatal mortality is a major public health problem in developing countries. In 2015, worldwide, 303,000 women died from complications of pregnancy and childbirth [1]. Most of these deaths are recorded in sub-Saharan Africa. In Senegal, despite the many efforts made over the past 20 years, the maternal mortality ratio still remains high, estimated at 236 per 100,000 live births. These deaths most often come from direct obstetric causes, including prolonged labour and obstructed labour, which represent 2.3% of the causes of maternal death in Senegal [2]. To reduce the proportion of obstructed labour among the causes of maternal death, a rigorous obstetrical evaluation is necessary at the end of pregnancy in order to decide on the best way of childbirth. In surgical basins, caesarean section will be performed before going into labour and in the case of a moderately narrowed pelvis, vaginal childbirth can be attempted under certain conditions. This is trial of labour, which remains little documented in Senegal and in the world where very few works are recorded. This is how we conducted this study, the objectives of which were to assess the frequency of moderately narrowed pelvises, to specify the epidemiological profile of patients and to evaluate the maternal and neonatal prognosis in the event of childbirth in a moderately narrowed pelvis.

Patients and Methods

Type, Setting and Period of Study

This was a descriptive and analytical retrospective study carried out over a period of 12 months from January 1st to December 31st, 2020 and concerning childbirths in a moderately narrowed pelvis at the Gynecology-Obstetrics Department of the Institut d'Hygiène Social Hospital of Dakar.

Patient Selection Criteria

We included patients who were carriers of a singleton pregnancy at term with a foetus in vertex presentation and a moderately shrunken pelvis which is a symmetric shrunken pelvis with smooth reduction of all diameters.

Data Collection and Analysis

Data were collected from birth records and entered using EPI INFO Version 7 software. Data analysis was done using Statistical Package for Social Sciences (SPSS) Version 21 software two parts:

A descriptive analysis: the qualitative variables were described in number, percentage and the quantitative variables on average with the standard deviation, the extremes and the median, and a bivariate analysis: it consisted of a comparison between the outcome of the work test and the other variables. The Chi2 test was used for proportion comparison. The difference was statistically significant when the p value was strictly less than 0.05.

Results

Descriptive Results

Frequency: During the study period, we recorded 2,156 childbirths, including 101 after a trial of labour, representing a frequency of 4.6% of childbirths.

Socio-Demographic Characteristics of Patients

The average age of the patients was 24 years old with extremes of 17 and 40 years old. The 21 to 30 age group was the most represented with a frequency of 48.5%. Almost all of the patients were married (96.9%), most often in a monogamous regime (69.7%). Most of them came from outside our health district (92.9%). The average parity was 1.1 with extremes of 0 and 4. Nearly three quarters of the patients (73.4%) were primiparous. The mean number of live births was 1±0.7 with extremes of 0 and 4. The majority of patients (94.7%) had previously given birth vaginally (Table 1).