Childbirth on a Moderately Shrinked Pelvis at the Institut D’hygiene Sociale Hospital in Dakar

Abstract

Objectives: To assess the frequency of moderately narrowed pelvises, to specify the epidemiological and clinical profile of parturients, the mode of childbirth and to evaluate the maternal and neonatal prognosis in patients who underwent a trial of labour at the IHS hospital between the January 1st, 2019 and December 31st, 2020. Patients and Methods: This was a descriptive and analytical retrospective study of all patients who underwent a trial of labour at the Gynaecology-Obstetrics Department of the IHS Hospital in Dakar between January 1st and December 31st, 2020, i.e. a period of 12 months. Data were collected from birth records. Data entry was performed with EPI INFO 7 software and analysis with SPSS 21 software. Results: During the study period, we performed 101 labour trials among the 2156 childbirths, a frequency of 4.6% of childbirths. The epidemiological profile of the patients was that of a primiparous woman (73.3%) with an average age of 24, married (96.9%), having carried out at least 3 prenatal consultations (90%) and carrying a pregnancy at term (97%). Clinically, the average fundal height was 33 cm with extremes of 27 and 40 cm. The majority of patients (73.3%) had a borderline pelvis while the transversely narrowed pelvis accounted for only 26.7% of cases. The introductory palpation was only performed in 17 patients (16.8%) and it was doubtful in 11 of them (10.9%). The trial of labour ended in vaginal childbirth in 34.7% of cases or in caesarean section in 65.3% of patients. Failure of the trial of labour was more frequent in nulliparous (76.9%) compared to primiparous (64.9%), pauciparous (72.7%) (p=0.082) and in patients with borderline pelvis (79.5%) compared to those who had a transversely narrowed pelvis (68.7%) (p=0.392). In our series, 12 new-borns (11.9%) had benefited from neonatal resuscitation and eleven of them, that is a rate of 10.8%, were transferred to a neonatology unit. These were cases of non-reassuring fetal status occurring during the expulsive phase. Their evolution was favourable in all cases. One early neonatal death (1%) was recorded. No maternal complication had been notified. Conclusion: Childbirths on a moderately narrowed pelvis are not uncommon in our practice. They require a prior clinical evaluation of the parturients, particularly with the introducer palpation in order to increase the chances of a favourable outcome and to avoid maternal and perinatal complications.