Predicting trends in operative delivery for cephalopelvic disproportion in Africa
1990; Elsevier BV; Volume: 335; Issue: 8693 Linguagem: Inglês
10.1016/0140-6736(90)90982-b
ISSN1474-547X
Autores Tópico(s)Urological Disorders and Treatments
ResumoCephalopelvic disproportion is the major obstetric complication in Africa due to maternal growth stunting from the combined effects of inadequate childhood nutrition and infection. Both short women and women who do not receive prenatal care contribute a disproportionate share of the cesarean sections performed in African countries. To gain more information on the effect of maternal height and fetal birthweight on delivery the 4702 births to hospitalized primigravidae included in the Zaire Birth Survey of 1984 were grouped according to these variables. The cesarean section rate was 57% in mothers 150 cm and below in height who had infants weighing under 3510 grams compared with 6% in tall mothers with infants of adequate birthweight. Moreover of the infants whose mothers had received prenatal care only 14% weighed 2500 grams and under 76% were in the 2510-3500 gram range and 10% weighed 3510 grams or more; the corresponding birthweight percentages for the group without prenatal care were 31% 65% and 4% respectively. The cesarean delivery rate cannot be expected to begin to decline dramatically once nutritional and health care standards improve. Since skeletal growth will have ceased in most pregnant women there will be a period in which short women bear heavy babies and a temporary increase in the incidence of fetopelvic disproportion. Thus any programs aimed at improved maternal nutrition and health care must be linked to the provision of safe operative delivery until a generation of African women has had the chance to avoid severe nutritional deprivation in the early years.
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