IJAR.2023.200
Type of Article: Original Research
Volume 11; Issue 4 (December 2023)
Page No.: 8721-8728
DOI: https://dx.doi.org/10.16965/ijar.2023.200
Validation of Sacral Rhomboid Diameters and Maternal Height in Antenatal Prediction of Contracted Pelvis in Primigravida
Prisha Rishi *1, Abhiruchi Patel 2, Ameet Julka 3, Garima Pardhi 4.
*1 Assistant Professor, Department of Anatomy, SAIMS Medical College And Postgraduate Institute, Indore Ujjain State Highway, near MR 10 Road, Bhawrasla, Indore, M.P. 453555, India. ORCiD: 0000-0001-7952-0436
2 Assistant Professor, Department of Anatomy, LNCT Medical College, Kanadiya, Indore, M.P. 452016, India.
3 Professor and Head, Department of Anatomy, MGM Medical College, AB Road, CRP Line Indore M.P. 452001, India. ORCiD: 0000-0001-8807-2030
4 Assistant professor, Department of Anatomy, A.B.V.G.M.C., NH 86, Sanchi Road, Shastri Nagar, Vidisha, M.P. 464001, India.
Corresponding Author: Dr. Prisha Rishi, Assistant Professor, Department of Anatomy, SAIMS Medical College And Postgraduate Institute, Indore Ujjain State Highway, near MR 10 Road, Bhawrasla, Indore, M.P. 453555, India. E-Mail: prishaa.riishi@gmail.com
ABSTRACT
Background: Contracted pelvis when not diagnosed on time before labour leads to obstetric mishaps in developing countries.
Material and Methods: This prospective study aimed to assess the validity of sacral rhomboid diameter and maternal height (Ht) to predict contracted pelvis antenatally and to compare its individual efficacy with the combination models in antenatal prediction of the contracted pelvis.
Results: In 250 uncomplicated primigravida at 37 weeks or beyond, Height and Michaelis sacral rhomboid vertical and transverse diameters (VD and TD) were measured. Post-delivery patients were divided into two groups- Normal delivery (Group1) and contracted pelvis(CP) (Group 2 including Lower Segment Caesarean Section (LSCS) for contracted pelvis and assisted vaginal delivery due to non-progress of labour). Analysis was done using Microsoft Excel and R studio (Open source analytical tool V 1.2.335), cross-tabulation, and Pearson chi-square test. In our study, we found that the Mean maternal height and mean rhomboid dimensions (VD and TD) were significantly (p value 0.000) smaller in the CP group. In univariate analysis, Maternal height≤1.422 (m), VD ≤9.5 (cm) and TD ≤9.5 (cm) showed PPV of 59.26%, 29.63%, and 56.67% respectively. Of all parameters, Maternal height≤1.422 (m) was the most significant factor in the prediction of contracted pelvis and it detected 16 out of 27 women at risk of CP. However, when combination models were produced, HT+TD was the best predictor model at 10th percentile cut-off values with the highest PPV and Accuracy (77.78% and 93.3% respectively) and it detected 14 out of 18 women at risk of CP.
Conclusions: Smaller dimensions of the sacral rhomboid along with the maternal height are independent predictors of contracted pelvis. Transverse diameter of Michaelis (TD) along with maternal height at cut-off values enhanced the predictability of contracted pelvis and can be used as a promising and easily measurable screening parameter to detect the women at risk of Contracted pelvis antenatally.
Keywords: Sacral Rhomboid diameters, Contracted pelvis, Antenatal Prediction, Maternal Height, Primigravida.
REFERENCES
[1]. Bansal A, Kalra R. Feto maternal outcome in obstructed labor: a tertiary centre study. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2019 Jun 1;8(6):2500.
[2]. Usharani N, Bendigeri M. A study on clinical outcome of obstructed labour. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2017 Feb 1;6(2):439-43.
[3]. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, Gülmezoglu AM, Temmerman M, Alkema L. Global causes of maternal death: a WHO systematic analysis. The Lancet global health. 2014 Jun 1;2(6):e323-33.
[4]. Bansal S, Guleria K, Agarwal N. Evaluation of sacral rhomboid dimensions to predict contracted pelvis: a pilot study of Indian primigravidae. The Journal of Obstetrics and Gynecology of India. 2011 Oct;61:523-7.
[5]. Aayog NI. Maternal Mortality Ratio (MMR)(per 100000 live births). Government of India. URL: https://www. niti. gov. in/content/maternal-mortality-ratio-mmr-100000-live-births (accessed 22nd May 2019). 2018.
[6]. Neitzke G, Hoffmann S. Gustav Adolph Michaelis–Physician, Researcher, Teacher. An acknowledgement for the anniversary year 1998. Der Gynäkologe. 1999 Aug;32(8):660-4.
[7]. Michaelis G. Das enge Becken nach eigenen Beobachtungen und Untersuchungen. American Journal of Obstetrics and Gynecology. 1977;129(6):695-696.
[8]. Liselele HB, Boulvain M, Tshibangu KC, Meuris S. Maternal height and external pelvimetry to predict cephalopelvic disproportion in nulliparous African women: a cohort study. BJOG: An International Journal of Obstetrics & Gynaecology. 2000 Aug;107(8):947-52.
[9]. Solomon D, Dirar A, Getachew F. Age, Anthropometric Measurements and Mode of Delivery among Primigravidae Women at Addis Ababa Governmental Hospitals, Ethiopia. J Women’s Health Care. 2018;7(01):2167-0420.
[10]. Deepika N, Kumar A, Shivagami C. Study of anthropometric measurements to predict contracted pelvis. Int J Clin Obstet Gynaecol. 2019;3:7-11.
[11]. Alijahan R, Kordi M, Poorjavad M, Ebrahimzadeh S. Diagnostic accuracy of maternal anthropometric measurements as predictors for dystocia in nulliparous women. Iranian journal of nursing and midwifery research. 2014 Jan;19(1):11.
[12]. Benjamin SJ, Daniel AB, Kamath A, Ramkumar V. Anthropometric measurements as predictors of cephalopelvic disproportion: can the diagnostic accuracy be improved?. Acta obstetricia et gynecologica Scandinavica. 2012 Jan;91(1):122-7.
[13]. Buchmann EJ. Head descent, moulding and other intrapartum clinical findings in the prediction of cephalopelvic disproportion.
[14]. Kara F, Yesildaglar N, Uygur D. Maternal height as a risk factor for Caesarean section. Archives of Gynecology and Obstetrics. 2005 Apr;271:336-7.
[15]. Kakoma JB, Karibushi J, Ramazani KR. Height, weight, external pelvic diameters and cesarean section: a cohort study in southern province of Rwanda (Huye District). Rwanda Medical Journal. 2010 Sep;68(3):21-4.
[16]. Siccardi M, Valle C, Di Matteo F, Angius V. A postural approach to the pelvic diameters of obstetrics: the dynamic external pelvimetry test. Cureus. 2019 Nov 9;11(11).
