A cross sectional study evaluating screening using maternal anthropometric measurements for outcomes of childbirth in Ugandan mothers at term.

Ian G Munabi,Florence Mirembe,Samuel Abilemech Luboga

doi:10.1186/s13104-015-1183-z

Abstract

BackgroundBirth related newborn and maternal mortality/morbidity remains high in most of sub-Saharan Africa compared to the rest of the world. In this low income region there is a need for valid, low cost, easy to use mass screening tests. This study looked at the screening value of maternal: height, weight and pelvis height, for assessing the outcomes of parturition in Ugandan mothers at term.MethodsThis was a multi site cross-sectional study on mothers with singleton pregnancies in labour at various hospitals in different parts of Uganda. A summary of the details of the pregnancy, maternal height, weight and the delivery record were captured and analysed to generate descriptive and inferential (multilevel logistic regression analysis) and diagnostic (Receiver Operator Curve analysis) statistics.ResultsWe recruited 1146 mothers from all the study sites during the study period of whom 987 (86.13%) had normal deliveries and healthy babies. Mothers with adverse outcomes included 107 mothers that had caesarean section and 52 mothers who had vaginal deliveries with foetal Apgar score of ≤7 at 5 min of whom 11 had fresh still births. Maternal height (Adj OR 0.97, 95% CI 0.94–1.00) and maternal pelvis height (Adj OR 0.73, 95% CI 0.61–0.86) were significantly associated with adverse pregnancy outcomes. The combination of maternal: height (<150 cm), weight (>55.7 kg) and pelvis height (>8.95 cm) had the best diagnostic value with a combined area under the curve of 0.60.ConclusionsIt was observed that an increase in either maternal pelvis height or maternal height was associated with a significant reduction in adverse pregnancy outcomes. The cut off values of all three evaluated maternal anthropometric measurements were of low test accuracy as screening tests even when used together. Further research is needed to develop low cost screening tools for use in low income settings.

Highlights

Birth related newborn and maternal mortality/morbidity remains high in most of sub-Saharan Africa compared to the rest of the world
The combination of the three anthropometric measurements using the cut offs of: maternal height (55.7 kg) and maternal pelvis height (8.95 cm) performs even better than maternal height (
We set out to evaluate the value of screening mothers for pregnancy adverse outcomes at parturition using maternal height, weight and pelvis height in a cohort of Ugandan mothers at term

Summary

Introduction

Birth related newborn and maternal mortality/morbidity remains high in most of sub-Saharan Africa compared to the rest of the world In this low income region there is a need for valid, low cost, easy to use mass screening tests. In local study at the national referral hospital in Uganda an early neonatal death rate of 109 deaths per 1,000 live births was observed, mainly attributed to respiratory distress and poor foetal monitoring during labour [6]. These high maternal and child mortalities are indicative of the delays and low quality of care received by mothers prior to and during parturition [7]. This is what has driven the development of technologies like ultrasound and more recently a renewed interest in doing pelvimetry as a method to improve prediction of the parturition outcomes [10, 11]

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