ABSTRACT
Cephalopelvic disproportion (CPD) is a common and serious obstetric condition,
especially in sub-Saharan Africa. Recognition relies on clinical observations, such as
cervical dilatation, head descent, moulding, and size of fetus, all made in a trial of labour.
No prospective studies have investigated intrapartum clinical observations and their
predictive value for CPD. The objectives of this research were 1) to determine the
association of intrapartum clinical findings, especially level of head and moulding, with
the outcome of CPD, 2) to determine inter-observer agreement of these findings between
clinicians, and 3) to compare intrapartum clinical palpation with symphysis-fundal height
(SFH) measurement in the prediction of birth weight.
A prospective cross-sectional comparative study was done in the Chris Hani
Baragwanath labour ward, a large referral centre. The subjects were women at term, in
the active phase of labour, with vertex presentations. The author, blinded to previous
clinical or ultrasound findings, performed clinical assessments at the same time as the
women’s attending clinicians. His observations were not divulged to the clinicians and he
did not participate in obstetric management of the women. The primary outcome
measures were CPD, defined as caesarean section for poor progress, and birth weight.
Five hundred and eight women were examined, of whom 113 (22.2%) had CPD.
Multivariate analysis identified short maternal stature, increased SFH, lesser cervical
dilatation, long duration of labour, high degree of parieto-parietal moulding, and high
degree of caput succedaneum as independent predictors for CPD. Fetal position and occipito-parietal moulding were not predictive, and level of head, by fifths and by station,
was poorly predictive. Inter-observer agreement between the author and attending
clinicians was moderate for cervical dilatation, engagement of the head in fifths, and
caput succedaneum, and poor for engagement of the head by station. SFH measurement
was a slightly better predictor of birth weight than clinical fetal weight estimation.
The clinical observations that were shown to be predictive for CPD may be useful
adjuncts in the management of a trial of labour. Inter-observer agreement of these
findings is at best moderate. Measurement of SFH deserves more attention as an
intrapartum predictor of birth weight.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/5056 |
| Date | 15 July 2008 |
| Creators | Buchmann, Eckhart Johannes |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | 394965 bytes, 9013 bytes, 3676918 bytes, 302076 bytes, 272123 bytes, 170684 bytes, application/pdf, application/pdf, application/pdf, application/pdf, application/pdf, application/pdf, application/pdf, application/pdf, application/pdf, application/pdf, application/pdf, application/pdf |
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