Safe Childbirth and Motherhood in African Great Lakes Region: External Pelvimetry in Nulliparae and Scheduled Caesarean Section

The authors have carried out a literature review of targeted relevant research with a focus on two countries of the African Great Lakes Region, i.e. Rwanda and the Democratic Republic of the Congo (DRC). The aim was to find a common thread between nulliparity and timely caesarean section through external clinical pelvimetry. Higher rates of nulliparity and caesarean section were found with poor outcome in terms of foeto-maternal prognosis. External clinical pelvimetry presented in Rwandan and Congolese nulliparae the same characteristics during pregnancy and at delivery: lower average values in comparison with multiparae who never experienced caesarean section; average values significantly lower in women who underwent caesarean than in those who delivered naturally; and a gradual and significant decrease in caesarean section rate as pelvic sizes increased. Cephalopelvic disproportion, the main cause of mechanical dystocia, was associated with significantly lower pelvic average values. On the basis of an appropriate tool to predict cephalopelvic disproportion and taking as an illustration of complication the case of obstetrical fistulas, the authors finally advocate the use of the pelvimeter to screen in time pelvises at higher risk for cephalopelvic disproportion in resource-constrained environment.