Abstract
Cephalopelvic disproportion (CPD)-related obstructed labor is accountable for 3–8% of the maternal deaths worldwide. The consequence of CPD-related obstructive labor in the absence of a Caesarian section (C/S) is often maternal or perinatal mortality or morbidity to the mother and/or the infant. Accurate and timely referral of at-risk mothers to health facilities where C/S is a delivery option could reduce maternal mortality in the developing world. The goal of this work was to develop and test the feasibility of a safe, low-cost, easy-to-use, portable tool, using a Microsoft Kinect 3D camera, to identify women at risk for obstructed labor due to CPD. Magnetic resonance imaging (MRI) scans, 3D camera imaging, anthropometry and clinical pelvimetry were collected and analyzed from women 18–40 years of age, at gestational age ≥36+0 weeks with previous C/S due to CPD (n = 43), previous uncomplicated vaginal deliveries (n = 96), and no previous obstetric history (n = 148) from Addis Ababa, Ethiopia. Novel and published CPD risk scores based on anthropometry, clinical pelvimetry, MRI, and Kinect measurements were compared. Significant differences were observed in most anthropometry, clinical pelvimetry, MRI and Kinect measurements between women delivering via CPD-related C/S versus those delivering vaginally. The area under the receiver-operator curve from novel CPD risk scores base on MRI-, Kinect-, and anthropometric-features outperformed novel CPD risk scores based on clinical pelvimetry and previously published indices for CPD risk calculated from these data; e.g., pelvic inlet area, height, and fetal-pelvic index. This work demonstrates the feasibility of a 3D camera-based platform for assessing CPD risk as a novel, safe, scalable approach to better predict risk of CPD in Ethiopia and warrants the need for further blinded, prospective studies to refine and validate the proposed CPD risk scores, which are required before this method can be applied clinically.
Highlights
Obstructed labor accounts for 3–8% of all maternal deaths worldwide and, in many countries, is almost as prevalent today as it was 30 years ago [1,2,3]
The proposed novel Cephalopelvic disproportion (CPD) risk score based on anthropometry, showed an AUCbest = 0.824 and AUCadj = 0.793; the latter was higher than any previously reported risk score that we considered applied to this group of Ethiopian women
The current study has several important limitations that should be mentioned. (i) Given the small sample size of this feasibility study, the proposed risk models require additional refinement, based on a larger sample size and cross-section of the population, and a broader, blinded, prospective, validation studies before this method can be applied clinically. (ii) We evaluated two risk models (Eq 1, with r1 and r2); there are numerous other options that can be taken from machine learning and data science that should be evaluated in future work. (iii) This study relied on recruitment of women with previous obstetric history of CPD, some of whom did not try labor
Summary
Obstructed labor accounts for 3–8% of all maternal deaths worldwide and, in many countries, is almost as prevalent today as it was 30 years ago [1,2,3]. Even if an Obstetrician suspects that a first-time pregnancy is at risk of CPD-related obstructed labor, the clinician will often prescribe trial of labor and, if the labor fails to progress, an emergency C/S is performed. The consequence of CPD-related obstructive labor (in the absence of C/S) is often maternal and/or perinatal mortality or long-term morbidity to the mother and/or the infant. Maternal and perinatal mortality in Ethiopia are among the highest in the world [7]; up to 22% of maternal deaths in Ethiopia have been attributed to CPD-related obstructed labor [7,8,9]. There is a pressing need to identify safe, low-cost methods for timely and accurate assessment of risk of obstructed labor from CPD in low resource settings [12]
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