Diagnostic accuracy of maternal anthropometric measurements as predictors for dystocia in nulliparous women

Abstract

Background: Dystocia is one of the important causes of maternal morbidity and mortality in low-income countries. This study wasaimed to determine the diagnostic accuracy of maternal anthropometric measurements as predictors for dystocia in nulliparous women.

Materials and Methods: This prospective cohort study was conducted on 447 nulliparous women who referred to Omolbaninhospital. Several maternal anthropometric measurements such as height, transverse and vertical diameters of Michaelis sacralrhomboid area, foot length, head circumference, vertebral and lower limb length, symphysio-fundal height, and abdominal girthwere taken in cervical dilatation ≤ 5 cm. Labor progression was controlled by a researcher blind to these measurements. Afterdelivery, the accuracy of individual and combined measurements in prediction of dystocia was analyzed. Dystocia was defi nedas cesarean section and vacuum or forceps delivery for abnormal progress of labor (cervical dilatation less than 1 cm/h in theactive phase for 2 h, and during the second stage, beyond 2 h or fetal head descend less than 1 cm/h).

Results: Among the different anthropometric measurements, transverse diameter of the Michaelis sacral rhomboid area ≤9.6 cm,maternal height ≤ 155 cm, height to symphysio-fundal height ratio ≤4.7, lower limb length ≤78 cm, and head circumference to heightratio ≥ 35.05 with accuracy of 81.2%, 68.2%, 65.5%, 63.3%, and 61.5%, respectively, were better predictors. The best predictorwas obtained by combination of maternal height ≤155 cm or the transverse diameter of the Michaelis sacral rhomboid area ≤9.6cm and Johnson’s formula estimated fetal weight ≥3255 g, with an accuracy of 90.5%, sensitivity of 70%, and specifi city of 93.7%.

Conclusions: Combination of other anthropometric measurements and estimated fetal weight with maternal height in comparisonto maternal height alone leads to a better predictor for dystocia.

Key words: Anthropometric measurements, cephalopelvic disproportion, dystocia, Iran