**Author details**

*Maternal and Child Health Matters Around the World*

prognosis could be considerably improved.

**7. Conclusion**

Therefore, it is obvious that obstetric fistula is a real public health problem in the DRC, and particularly in nulliparae. Concerning prolonged labour and caesarean section performed under inappropriate conditions, other equally serious complications are uterine rupture, which compromises the reproductive capacity, as well as the high maternal and perinatal morbidity and mortality. And yet all this would be avoidable if we could act upstream by predicting the outcome of the pregnancy (i.e. the way of delivery) with a high probability so that the maternal and perinatal

Results from studies on childbirth and motherhood in two countries of the African Great Lakes Region, namely Rwanda and the Democratic Republic of the Congo, highlighted high rates of nulliparity, which have had a deleterious effect on obstetrical and perinatal outcomes. Higher rates of caesarean section have been observed, especially in nulliparous women. One of the most frequent indications of caesarean section was cephalopelvic disproportion that leads to prolonged and obstructed labour in a context of lack of qualified health professionals. As most of the time, cephalopelvic disproportion results from pelvis inadequacy to allow the foetus to negotiate the birth canal, pelvic diameters represent the essential parameters to be taken into account in predicting the route of delivery and preventing serious maternal and perinatal complications following caesarean sections in poor conditions. In Rwanda as well as in DRC a significant relationship has been found between accessible external pelvic diameters and obstetrical outcomes (natural delivery and caesarean section), while cephalopelvic disproportion was the main caesarean section indication. This relies heavily on the question of the usefulness of pelvic evaluation in nulliparae during pregnancy in countries with limited resources, especially in remote areas. It is therefore a noble human duty to seek appropriate, efficient and evidence-based solutions and tools to help improve the health of the mother-child couple, which is part of all global goals. In this context, the early detection of nulliparae at higher risk of cephalopelvic disproportion, as soon as they are pregnant, would protect them and their infants by avoiding unscheduled caesarean sections and complications that could have life-long consequences or could endanger life. We believe that pelvimeter, this simple affordable tool, could be, in expert hands, one of those needed tools in resource-limited settings. Pregnant youngsters could thus benefit from the advantageous effects of a timely caesarean section and enjoy a safe motherhood, and besides, childbirth

would not at all be a very dangerous event for both mother and child.

**84**

Jean-Baptiste Kakoma1,2,3\*, Xavier Kinenkinda1 , Fanny Malonga1 , Joseph Nsambi1 , Micrette Ngalula1 , Jeanne Ngoy1 and Jean Kalibushi3

1 Department of Obstetrics and Gynaecology, University of Lubumbashi School of Medicine, Democratic Republic of the Congo

2 Department of Epidemiology, University of Lubumbashi School of Public Health, Democratic Republic of the Congo

3 Department of Obstetrics and Gynaecology, University of Rwanda College of Medicine and Health Sciences, Rwanda

\*Address all correspondence to: jbszkakoma2016@gmail.com

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
