*5.2.4 External pelvic diameters in nulliparae and caesarean section in Rwanda*

A prospective, longitudinal and descriptive study was conducted in 152 Rwandan parturients out of the 312 nulliparae who participated in a previous study on external clinical pelvimetry at antenatal care settings in Huye District/Southern Province of the country [58]. From December 2007 to April 2008, the investigators went over all the health centres and hospitals in the Huye District to look for deliveries of nulliparae involved in the abovementioned survey. Apart from pelvic and anthropometric measurements (already taken at antenatal care settings), the only considered medical parameters were the mode of delivery, the vertex presentation of the foetus, and singleton live birth. Deliveries and caesarean sections were blindly performed by midwives, general practitioners and specialists who did not take part in the survey. Yates' chi-square test was used to compare observed proportions. Results showed that caesarean section rates were more or less higher for values below the predefined thresholds for pelvic diameter sizes, i.e. average minus one standard deviation (**Table4**). The difference was only significant for the base of the Trillat's triangle and the intertuberous diameter [61].


#### **Table 4.**

*Pelvic diameters and caesarean section in Rwandan nulliparae.*

#### *5.2.5 External pelvic diameters in nulliparae and caesarean section in DRC*

A descriptive cross-sectional study was conducted in Lubumbashi from February 2016 to August 2017 in 400 nulliparae in order to compare ways of delivery associated with different sizes of two external pelvic diameters, namely the intertuberous diameter and the base of the Trillat's triangle. Pelvic measurements were already taken at antenatal care settings and the following parameters were collected after delivery: the mode of delivery, the vertex presentation of the foetus, and singleton live birth. Deliveries and caesarean sections were blindly performed by midwives, general practitioners and specialists who did not take part in the survey. Yates' chi-square and Student's *t* test were used to compare observed proportions and average values, respectively. Lowest dimensions of the base of the Trillat's triangle or prepubic diameter (i.e. <11 cm) and of the intertuberous diameter (i.e. <8 cm) were associated with higher caesarean section rates (i.e. 69.23 and 91.67% respectively) while highest dimensions (i.e. ≥16 and ≥12 cm respectively) were associated with lower caesarean section rates (8.33 and 5% respectively) in nulliparae, and

**81**

*#*

*\**

**Table 7.**

*Safe Childbirth and Motherhood in African Great Lakes Region: External Pelvimetry…*

versus 10.27 ± 1.10 cm for the intertuberous diameter (*p* < 0.001) [62].

than in those who gave birth naturally (**Table 7**) [63].

*Trillat's triangle base and obstetrical outcome in nulliparae in DRC.*

*Intertuberous diameter and obstetrical outcome in nulliparae in DRC.*

**Pelvic diameters (cm) Caesarean**

*Pelvic diameters and obstetrical outcome in nulliparae in DRC.*

**Trillat's triangle base (cm)**

 *test with Yates' correction.*

 *test with Yates' correction.*

*Baudelocque's diameter minus9 cm.*

*Wilcoxon signed-rank test.*

**Intertuberous diameter (cm)**

*\* χ 2*

*\* χ 2*

**Table 6.**

**Table 5.**

the difference was highly significant. On the whole, there was a gradual decrease in caesarean section rates as the size of the base of Trillat's triangle and of the intertuberous diameter increased (**Tables 5** and **6**). Related average diameter sizes were also significantly lower in women who delivered by caesarean section, i.e. 11.99 ± 1.37 cm versus 12.82 ± 1.39 cm for the prepubic diameter, and 9.10 ± 1.23 cm

At the same time and under the same conditions, 453 nulliparae were involved in a concomitant descriptive cross-sectional study about other external pelvic diameters. The same relationship was reproduced with regard to average sizes of pelvic diameters, which were significantly lower in women who have undergone caesarean

**Caesarean Vaginal delivery Total** *p***\***

**Caesarean Vaginal delivery Total** *p\**

**Vaginal delivery Mean ± SD (Median)** *p***\***

*N* **%** *N* **%** *N* **%**

<7.9 11 91.67 1 8.33 12 100 <0.001

**Mean ± SD (Median)**

Biiliac 25.46 ± 2.10 (25 cm) 24.14 ± 1.92 (24 cm) <0.001 Antero-superior iliac interspinous 21.80 ± 2 (22 cm) 23.03 ± 2.31 (23 cm) <0.001 Intertrochanter 27.68 ± 2.24 (28 cm) 29.44 ± 2.82 (29 cm) <0.001 Baudelocque 18.34 ± 1.77 (18 cm) 20.78 ± 1.88 (20 cm) <0.001 Conjugata vera pelvis# 9.35 ± 1.76 (9 cm) 11.79 ± 1.92 (11 cm) <0.001

8–8.9 23 69.70 10 30.30 33 100 9–9.9 30 29.70 71 70.30 101 100 10–10.9 31 24.60 95 75.40 126 100 11–11.9 8 9.09 80 90.91 88 100 ≥ 12 2 5.00 38 95.00 40 100

*N* **%** *N* **%** *N* **%**

<11 18 69.23 8 30.77 26 100 <0.001

11–11.9 28 38.89 44 61.11 72 100 12–12.9 26 24.30 81 75.70 107 100 13–13.9 19 19.39 79 80.61 98 100 14–14.9 10 17.54 47 82.46 57 100 15–15.9 3 10.71 25 89.29 28 100 ≥16 1 8.33 11 91.67 12 100

*DOI: http://dx.doi.org/10.5772/intechopen.89638*

#### *Safe Childbirth and Motherhood in African Great Lakes Region: External Pelvimetry… DOI: http://dx.doi.org/10.5772/intechopen.89638*

the difference was highly significant. On the whole, there was a gradual decrease in caesarean section rates as the size of the base of Trillat's triangle and of the intertuberous diameter increased (**Tables 5** and **6**). Related average diameter sizes were also significantly lower in women who delivered by caesarean section, i.e. 11.99 ± 1.37 cm versus 12.82 ± 1.39 cm for the prepubic diameter, and 9.10 ± 1.23 cm versus 10.27 ± 1.10 cm for the intertuberous diameter (*p* < 0.001) [62].

At the same time and under the same conditions, 453 nulliparae were involved in a concomitant descriptive cross-sectional study about other external pelvic diameters. The same relationship was reproduced with regard to average sizes of pelvic diameters, which were significantly lower in women who have undergone caesarean than in those who gave birth naturally (**Table 7**) [63].


#### **Table 5.**

*Maternal and Child Health Matters Around the World*

Intercrestal <22

Interspinous <20

Intertrochanteric <28

Intertuberous <8

Anteroposterior <17

Base of Trillat's triangle <11

 *test with Yates' correction.*

≥22

≥20

≥28

≥ 8

≥17

≥11

*Pelvic diameters and caesarean section in Rwandan nulliparae.*

*5.2.4 External pelvic diameters in nulliparae and caesarean section in Rwanda*

*5.2.5 External pelvic diameters in nulliparae and caesarean section in DRC*

A descriptive cross-sectional study was conducted in Lubumbashi from February 2016 to August 2017 in 400 nulliparae in order to compare ways of delivery associated with different sizes of two external pelvic diameters, namely the intertuberous diameter and the base of the Trillat's triangle. Pelvic measurements were already taken at antenatal care settings and the following parameters were collected after delivery: the mode of delivery, the vertex presentation of the foetus, and singleton live birth. Deliveries and caesarean sections were blindly performed by midwives, general practitioners and specialists who did not take part in the survey. Yates' chi-square and Student's *t* test were used to compare observed proportions and average values, respectively. Lowest dimensions of the base of the Trillat's triangle or prepubic diameter (i.e. <11 cm) and of the intertuberous diameter (i.e. <8 cm) were associated with higher caesarean section rates (i.e. 69.23 and 91.67% respectively) while highest dimensions (i.e. ≥16 and ≥12 cm respectively) were associated with lower caesarean section rates (8.33 and 5% respectively) in nulliparae, and

A prospective, longitudinal and descriptive study was conducted in 152 Rwandan parturients out of the 312 nulliparae who participated in a previous study on external clinical pelvimetry at antenatal care settings in Huye District/Southern Province of the country [58]. From December 2007 to April 2008, the investigators went over all the health centres and hospitals in the Huye District to look for deliveries of nulliparae involved in the abovementioned survey. Apart from pelvic and anthropometric measurements (already taken at antenatal care settings), the only considered medical parameters were the mode of delivery, the vertex presentation of the foetus, and singleton live birth. Deliveries and caesarean sections were blindly performed by midwives, general practitioners and specialists who did not take part in the survey. Yates' chi-square test was used to compare observed proportions. Results showed that caesarean section rates were more or less higher for values below the predefined thresholds for pelvic diameter sizes, i.e. average minus one standard deviation (**Table4**). The difference was only significant for the base of the Trillat's triangle and the intertuberous diameter [61].

**Diameters (cm) Way of delivery** *p***\***

11 (68.7%) 100 (80.1%)

7 (77.8%) 113 (79%)

23 (71.9%) 97 (80.8%)

4 (44.4%) 116 (81.1%)

23 (71.9%) 97 (80.83%)

0 (0.00%) 120 (81.1%)

**Per vaginam (***N* **= 120) Caesarean (***N* **= 32)**

5 (31.3%) 27 (19.9%)

2 (22.2%) 30 (21%)

9 (28.1%) 23 (19.2%)

5 (55.6%) 27 (18.9%)

9 (28.1%) 23 (19.17%)

4 (100%) 28 (18.9%) 0.290

0.929

0.269

0.009

0.260

0.001

**80**

*\*χ 2*

**Table 4.**

*Trillat's triangle base and obstetrical outcome in nulliparae in DRC.*


#### **Table 6.**

*Intertuberous diameter and obstetrical outcome in nulliparae in DRC.*


#### **Table 7.**

*Pelvic diameters and obstetrical outcome in nulliparae in DRC.*
