*5.2.7 Pelvic dystocia and external pelvic diameters in DRC*

A cross-sectional descriptive study with an analytical component in nulliparae (*n* = 535) was conducted in seven referral hospitals in the city of Lubumbashi from February 2016 to August 2017 in order to describe the morphological characteristics (anthropometric and pelvimetric externally) and to identify their thresholds for the specification of appropriate determinants and the development of a predictive score for the type of delivery (vaginal versus caesarean) in pregnant women. Only 535 nulliparae who gave birth with singleton pregnancy at term and vertex presentation were involved in this study; and only caesarean sections indicated for mechanical dystocia were considered. A predictive score (TABIT score: TA for "taille", i.e. height; BI for "bi-ischiatique", i.e. intertuberous; and T for "Trillat", i.e. prepubic diameter) was defined after logistic modelling to predict the occurrence of mechanical dystocia. Three criteria emerged as predictors (determinants) of mechanical dystocia: maternal height < 150 cm (OR adjusted = 2.96 [1.49–5.87]), bi-ischiatic or intertuberous diameter < 8 cm (OR adjusted = 15.96 [3.46–73.56]) and Trillat's triangle base or prepubic diameter < 11 cm (OR adjusted = 2.34 [1.36–4.01]). The total number of points attributed to the three determinants was 5 (<2 = low risk,

**83**

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

2–3 = moderate risk, and >3 = high risk). This scoring system had a sensitivity of 23. 81%, a specificity of 97.80%, a predictive value of a positive test of 76. 92%, and that of a negative test of 80.65%. The area under the ROC curve was 0.6549, within the range of acceptable values [64]. Although this tool can already be operational in conjunction with clinical data, efforts will be made to improve this scoring system by including one additional parameter to increase sensitivity, and uterine height as a proxy for foetal parameters is the most targeted obstetrical variable. In so doing, we could have a simple and cheap tool, usable by any health professional at antenatal

Home-birth practice usually happens in remote rural areas where qualified health professionals are rare, even absent or unknown; this is the case in most conflict areas of DRC and particularly in Upper Katanga province for several years past. In these conditions, the matrons are at work without any restraint. The tacit rule is to give birth whatever the cost by natural way. In a context of financial and geographical barriers, and facing the lack of qualified health staff coupled with the lack of adequate infrastructure and equipment, one has no choice but to wait for a possible favourable evolution of childbirth under the supervision of the matrons or any other person in charge of the parturients in the community who often do not hesitate to resort to the traditional medication. All this may result in obstructed labour or dystocia, which often occurs when the foetal head is stuck in the mother's pelvis, interrupting blood flow to the surrounding tissues. This results afterwards in prolonged ischemia which may progress to tissue necrosis, the fall of which leads to fistulas formation. Most of the time, cephalopelvic disproportion, which is one of the most frequent indications of caesarean section in nulliparae in our environment [41, 55, 56], is the primum movens of this process. Obstetric fistulas (urogenital) have debilitating consequences such as urinary incontinence, faecal incontinence or both, and damage to the vulva and thighs. They bring about well-known social ostracism and dehumanising stigmatisation with a urge impact on social, psychological, and sexual life of patients, more particularly in a context of extreme socioeconomic precariousness. In developed countries the incidence of vesicovaginal fistula is 0.3–2%, while it is not known in developing countries because of the underreporting of cases; and if it can be annually estimated, only a certain portion

A descriptive cross-sectional study was carried out from September 2009 to December 2013 in Upper Katanga Province (DRC) after five mass treatment campaigns in six health districts (Pweto, Kilwa, Mitwaba, Kasenga, Kashobwe and Lubumbashi). This study that involved 242 patients depicted a gloomy situation about sociodemographic and obstetrical characteristics of these patients at the time of fistula: 40.1% aged <20, 90.6% of nulliparae, 94.6% of vaginal delivery; 85.9% of ≥48 hours labour duration, 70.7% of home-birth practice, 93.4% of neonatal mortality, and 71.5% of patients living alone. Clinical parameters related to fistula were as follows: a history of fistula of 5 years and more (33.5%), vesico-vaginal fistula (96%) and failure of fistula repair (14%) [68]. This situation is only the tip of an iceberg as not all women concerned could be reached by the awareness campaigns.

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

**6.1 Background**

can benefit from treatment [65–67].

**6.2 Findings in DRC**

clinics and after parturients admission to delivery room.

**6. Home-birth practice and vaginal childbirth at all costs**

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

2–3 = moderate risk, and >3 = high risk). This scoring system had a sensitivity of 23. 81%, a specificity of 97.80%, a predictive value of a positive test of 76. 92%, and that of a negative test of 80.65%. The area under the ROC curve was 0.6549, within the range of acceptable values [64]. Although this tool can already be operational in conjunction with clinical data, efforts will be made to improve this scoring system by including one additional parameter to increase sensitivity, and uterine height as a proxy for foetal parameters is the most targeted obstetrical variable. In so doing, we could have a simple and cheap tool, usable by any health professional at antenatal clinics and after parturients admission to delivery room.
