*5.2.2 Pelvic measurements in multiparae and nulliparae in Kigali City/Rwanda*

A cross-sectional and analytical study was also carried out in Kigali City (Kigali University Teaching Hospital and Muhima District Hospital) from May 2009 to June 2010 in nulliparae (*n* = 318) and multiparae (*n* = 303) at admission in delivery rooms. One of the specific objectives of the study was also to describe and characterise pelvic and anthropometric parameters in Rwandan pregnant women in an urban area. Student's t test was used to compare average values observed in multiparae and nulliparae. Average sizes in multiparae who never experienced caesarean section were also significantly greater than in nulliparae for all considered pelvic diameters (**Table 2**). The same abovementioned implication about pelvis suitability in multiparae was suggested while average pelvic sizes in both multiparae and nulliparae were smaller in rural women from the rural area (Southern Province) than in their urban counterparts (Kigali City). Nutritional status was suggested as the factor that would explain this difference [59].


#### **Table 2.**

*Maternal and Child Health Matters Around the World*

**5.2 Findings in Rwanda and DRC**

*of Rwanda*

and DRC (Lubumbashi, Upper Katanga Province).

**Diameters (cm) Multiparae (***N* **= 314)**

products of researches conducted in Rwanda (Southern Province and Kigali city)

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.

*5.2.1 Pelvic measurements in multiparae and nulliparae in the Southern Province* 

Huye District in the Southern Province of Rwanda served as the framework of a cross-sectional and analytical study in nulliparae (*n* = 312) and multiparae (*n* = 314) at prenatal care settings on randomly fixed days from December 2007 to January 2008. Pelvic measurements were taken and average pelvic sizes in multiparae who have always delivered per vaginam were compared to those in nulliparae (Student's *t* test). The aim of the study was to describe and characterise external pelvic parameters in Rwandan pregnant women in a rural area. Average sizes were significantly greater in multiparae than in nulliparae except for the intertrochanter diameter and the base of the Trillat's triangle (**Table 1**). These preliminary findings suggested the fact that external pelvic diameters of multiparous women without previous caesarean experience would belong to pelvises best suited for delivery. It is worth noting that measurements in both multiparae and nulliparae were normally distributed (Kolmogorov-Smirnov test) [58].

**Mean ± SD**

*Comparison of pelvic diameters between Rwandan multiparae and nulliparae in the Southern Province.*

Intercrestal (biiliac) 23.92 ± 1.56 23.38 ± 1.60 0.001 Interspinous 22.20 ± 1.60 21.74 ± 1.58 0.001 Intertrochanteric 27.32 ± 1.98 27.04 ± 2.12 0.087 Intertuberous 9.67 ± 0.68 9.22 ± 0.76 0.001 Anteroposterior 17.92 ± 1.61 17.48 ± 1.50 0.001 Base of Trillat's triangle 13.43 ± 0.84 13.78 ± 1.00 0.001

**Nulliparae (***N* **= 312) Mean ± SD**

*p***\***

**78**

**Table 1.**

*\*Student's t test.*

*Comparison of pelvic diameters between Rwandan multiparae and nulliparae in Kigali city.*
