Diagnostic accuracy of sacral rhomboid dimensions in prediction of cephalopelvic disproportion in primigravidae
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20211123Keywords:
Cephalopelvic disproportion, Sacral rhomboid dimensions, Primigravidae, Caesarean sectionAbstract
Background: Cephalopelvic disproportion (CPD) is associated with significant maternal and fetal morbidity and mortality in developing countries. CPD complicates 2-15% of pregnancies. This study aimed to determine the diagnostic accuracy of sacral rhomboid dimensions in the prediction of CPD in primigravidae
Methods: This prospective study was conducted on 400 primigravidae at 37-week gestation in Department of Obstetrics and Gynaecology at Lady Hardinge Medical College, New Delhi. Women with height>145 cm were subjected to measurement of transverse and vertical diagonals (TD and VD) of sacral rhomboid prior to delivery. Following delivery, the women were divided in two groups: control group (normal delivery, n=290) and study group (caesarean section for CPD, n=56). The sacral rhomboid dimensions were compared in both the groups and statistically analysed.
Results: The mean maternal height in both the groups showed no significant difference (156.88±5.7 vs 155.02±4.75, p=0.011). However, in univariate analysis, maternal height of≤154.5 cm, VD ≤10.25 cm and TD≤9.75 cm showed a diagnostic accuracy of 58.3%, 55.4% and 78%, respectively. Of all the parameters, TD≤9.75 cm was the most significant factor in predicting CPD (34% vs 13%), OR 3.3 (95%CI: 1.7- 6.7, p<0.001).
Conclusions: A simple measurement of transverse diameter of sacral rhomboid is a better predictor of CPD in an average height Indian primigravidae. It can be used in community hospital to detect high risk primigravidae.
References
World Health Organization. The World Health Report 2005: Making every mother and child count. Geneva: World Health Organization, 2005.
Spert H. Gustav Adolf Michaelis and Michaelis’ Rhomboid. Obstetric and Gynaecologic Milestones Illustrated. New York: Parthenon Publishing Group. 1996:162-5.
Bansal S, Guleria K, Agarwal N. Evaluation of Sacral Rhomboid Dimensions to Predict Contracted Pelvis: A Pilot Study of Indian Primigravidae. J Obstet Gynecol Ind. 2011;61(5):523-7.
Rossiter CE, Chong H. Relations between maternal height, fetal birthweight and cephalopelvic disproportion suggest that young Nigerian primigravidae grow during pregnancy. Int J Obstet Gynaecol. 1985;92:40-8.
Deepika N, Kumar A, Shivagami C. Study of anthropometric measurements to predict contracted pelvis. International J Clin Obstet Gynaecol. 2019;3(1):07-11.
Heevy MA, Shahla KA. Maternal height-neonatal birth weight as a risk factor for Caesarean section due to failure of progress in labour. 2006
Kara F, Yesildaglar N, Uygur D. Maternal Height as a Risk Factor for Caesarean Section. Arch Gynecol Obstet. 2005;271(4):336-7.
8Baird D. Dystocia due to faults in the pelvis. Brit J Obstet Gynaecol. 1985;92: 1235–45.
Benjamin SJ, Daniel AB, Kamath A, Ramkumar V. Anthropometric measurements as predictors of cephalopelvic disproportion. Acta obstetricia et gynecologica Scandinavica. 2012;91(1):122-7.
Helen AB. Anthropometric measures as a predictor of cephalopelvic disproportion. Trop Doct. 1997;27:135-8.
Bruno D, Roger VC, Thierry L. The value of maternal height as risk factor of dystocia: A meta-analysis. Trop Med Int Health. 1996; 1:510-21.
Young TK, Woodmansee B. Factors those are associated with caesarean delivery in a large private practice: the importance of pre-pregnancy body mass index and weight gain. Am J Obstet Gynecol. 2002;187:312-8
Alijahan R, Kordi M, Poorjavad M, Ebrahimzadeh S. Diagnostic accuracy of maternal anthropometric measurements as predictors for dystocia in nulliparous women. Iran J Nurs Midwifery Res. 2014;19(1):11-8.
Rozenholc AT, Ako SN, Leke RJ, Boulvain M. The diagnostic accuracy of external pelvimetry and maternal height to predict dystocia in nulliparous women: a study in Cameroon. Int J Obstet Gynaecol. 2007;114(5):630-5.
Liselele HB, Boulvain M, Tshibangu KC, Meuris S. Maternal height and external pelvimetry to predict cephalopelvic disproportion in nulliparous African women: a cohort study. Int J Obstet Gynaecol. 2000;107(8):947-52.
Wianwiset W. Risk factors of cesarean delivery due to cephalopelvic disproportion in nulliparous women at Sisaket Hospital. Thai J Obstet Gynaecol. 2011;19:158-64.
