**5. External pelvimetry and ways of delivery in nulliparae and multiparae**

#### **5.1 Background**

Since more than two centuries, women pelvic architecture and pelvic girdle measurements have been a matter of scientific concern for obstetricians. Women pelvis and pelvimetry have been deeply studied in the eighteenth and the nineteenth century by a number of eminent scientists among whom Hendrik Van Deventer, Jean Louis Baudelocque, Gustav Adolf Michaelis, Franz Karl Joseph Naegele, Stein Jr., and Carl Conrad Theodor Litzman [57]. Different types of pelvimeters became common tools in maternity wards and delivery rooms. In the past, young trainees in medicine, assistants in obstetrics and midwives constantly and regularly used these pelvimeters, which were familiar to them. Gradually, this instrument disappeared from hospital maternities to end up only in a few health centres held by old nuns. This was the case in Rwanda and DRC. Moreover, the effectiveness of pelvimeter has for some time become questionable for most obstetricians under the pressure of advances in technology during the ending twentieth century and given the alleged lack of satisfactory scientific evidence [21, 22]. However, we are still living in a world where health care equity and access to quality health care remain to date an unattainable dream worldwide and even when it comes to different social classes within some industrialised countries. Therefore, it is the duty of scientists and men in the field to look for simple ways and inexpensive tools to help the many left behind, especially young pregnant women in resource-constrained countries in an environment dominated by all kinds of barriers. It is in this context that a number of studies have been conducted on the relationship between anthropometric parameters including height, weight as well as external pelvic diameters and ways of delivery in some parts of the world, and more particularly in Sub-Saharan Africa, Central Africa and African Great Lakes region [25–28]. Reported findings below are

products of researches conducted in Rwanda (Southern Province and Kigali city) and DRC (Lubumbashi, Upper Katanga Province).

## **5.2 Findings in Rwanda and DRC**

Results from Rwanda and DRC were obtained from research projects carried out either within the framework of an institutional cooperation (Southern Province of Rwanda) or as requirements for academic degrees of master's or PhD in medicine (Kigali/Rwanda and Lubumbashi/DRC) under the scrutiny of a same supervisor in 2007, 2010 and 2017. Data were collected at antenatal care clinics and at admission to delivery rooms in nulliparae and multiparae. Statistics central values and spread were identified for different external pelvic diameters and two other anthropometric parameters (height and weight). Concerned pelvic parameters were: intercrestal or biiliac diameter, interspinous diameter, intertrochanteric diameter, anteroposterior (Baudelocque's) diameter or external conjugate, intertuberous or bi-ischiatic diameter, and the base of Trillat's triangle or prepubic diameter. Only multiparae with no previous caesarean experience and nulliparae without pelvic malformations were selected so that measurements in multiparae were considered as base normal sizes while those in nulliparae could be considered as a mixture of normal and abnormal pelvic sizes as long as they had not yet faced the process of childbirth in the same environment (rural and urban areas in Rwanda, and urban area in DRC). Later on, delivery ways were observed in only nulliparous women with a single foetus in vertex presentation.
