Prevalence, and Associated Factors of Cephalopelvic Disproportion Among Pregnant Women Attending Delivery Services at Wachemo University, Nigist Elleni Mohammed Memorial Referral Hospital, Southern Ethiopia

doi:10.21203/rs.3.rs-4849671/v1

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Prevalence, and Associated Factors of Cephalopelvic Disproportion Among Pregnant Women Attending Delivery Services at Wachemo University, Nigist Elleni Mohammed Memorial Referral Hospital, Southern Ethiopia

https://doi.org/10.21203/rs.3.rs-4849671/v1

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Introduction:

Cephalopelvic disproportion (CPD) is a condition in which the baby's head is too large or the mother's pelvis is too small, making it difficult for the baby to pass through the birth canal during labor even if the uterine contraction is strong enough. This can lead to prolonged or obstructed labor, which poses serious risks to both the mother and the baby. The magnitude and risk factors contributing to cephalopelvic disproportion in Ethiopia are poorly understood.

Objectives

To assess the prevalence and associated factors of cephalopelvic disproportion among pregnant women attending delivery service at Wachemo University Nigist Elleni Mohammed Memorial Referral Hospital, Southern Ethiopia.

Methods

An institutional-based quantitative cross-sectional study design was implemented on 384 randomly selected pregnant women attending delivery service at Wachemo University Nigist Elleni Mohammed Memorial Referral Hospital from September-December 2023. The primary data were collected by using structured questionnaires and checklists. The history taking, anthropometric measurements, physical examination, and CPD diagnosis were performed by the gynecologist and obstetricians. The data were collected by the four BSc midwives under strict supervision. After being carefully checked for the completeness, accuracy, and validity of each questionnaire, the data were entered into Epi-data and then exported to SPSS version 25 for analysis. Descriptive statistics, bivariate and multivariable logistic regression analyses were performed.

Results

The prevalence of cephalopelvic disproportion was 13.8%. The decrease in one centimeter of the maternal height triples the chance of developing the CPD [AOR = 3 (95% CI: 1.76–5.24)]. A unit increment in fetal head circumference doubles the likelihood of the developing the CPD [AOR = 2 (95% CI: 1.47–4.95)]. One gram increment in fetal weight increases the chance of developing CPD by 3.5 folds [AOR = 3.8 (95% CI: 1.12–5.88)]. Maternal diabetes mellitus [AOR = 2.8 (95% CI: 1.17–5.32)] was another significantly contributing factor to CPD.

Conclusion

The prevalence of cephalopelvic disproportion was high. The significantly contributing factors for CPD were short maternal height, large fetal birth weight, wider fetal head circumference, and maternal diabetes mellitus. Adequate younghood nutrition, proper dietary intake during pregnancy, complete antenatal service, and controlling blood glucose level were recommended.

Health sciences/Anatomy

Health sciences/Cardiology

Health sciences/Gastroenterology

Health sciences/Health occupations

Health sciences/Medical research

Health sciences/Molecular medicine

Health sciences/Risk factors

Prevalence

Associated factors

Cephalopelvic Disproportion

Maternal Pelvic Anthropometries

Ethiopia

The cephalopelvic disproportion (CPD) is a condition in which the baby's head is too large or the mother's pelvis is too small, making it difficult for the baby to pass through the birth canal during labor even if the uterine contraction is strong enough. This can lead to prolonged or obstructed labor, which poses serious risks to both the mother and the baby (1). The CPD is a common obstetric problem in the World commonly very serious in developing regions like Asia and in sub-Saharan Africa (2). According to the World Health Organization (WHO) report, globally, obstructed labor was the direct clinical consequence of CPD, and it amounts to 8% of maternal death (3). The CPD is the most common indication for primary cesarean delivery CPD (4).

There are many consequences of obstructed labor, which are birth canal trauma, postpartum hemorrhage, and genital infections (5). Women who experience CPD often undergo surgical interventions such as emergency cesarean section, vacuum, or forceps deliveries, which cause maternal complications like obstetric fistula, intrauterine infection, uterine rupture, postpartum hemorrhage, and laceration of the cervix, and fetal complications like asphyxia leading to stillbirth and neonatal death. The condition is further worsened when there is poor delivery care and resource-strained regions like Sub-Saharan Africa in general and Ethiopia in particular that frequently result in maternal or perinatal mortality or morbidity (6–9).

According to several studies, there were many factors associated with CPD. The maternal and fetal anthropometric factors like short stature, maternal limb length, maternal pelvimetries, maternal obesity, fetal birth weight, and fetal head circumference were believed to be risk factors for CPD (10). The external dimensions of the pelvis are closely related to its internal dimensions. Then, the efficiency of external pelvimetry used as a screening test for cephalopelvic disproportion (11). The other category of factors that are believed to be contributing to CPD are obstetric and gynecologic factors like maternal diabetes mellitus, previous CS delivery, polyhydramnios, infertility treatment, gestational age, and maternal obesity (12).

In Ethiopia, CPD is a significant concern due to various factors such as limited access to quality prenatal care, inadequate nutrition, and high rates of teenage pregnancies. These factors contribute to an increased risk for CPD and its associated complications in Ethiopian women (13, 14). Additionally, cultural and traditional practices, as well as a lack of awareness about the importance of seeking timely medical intervention during childbirth, can further exacerbate the impact of CPD in Ethiopia. Efforts to address CPD in Ethiopia include initiatives to improve access to skilled birth attendants, promote antenatal care, and raise awareness about the risks and signs of CPD (15). However, challenges such as limited healthcare infrastructure and resources continue to hinder progress in addressing this issue (11). The detection of mothers at a higher risk of CPD is important for higher preventive measures, close attention or preparation of CS is yet to be done (15).

In Ethiopia in general and in the study area in particular, the magnitude of the CPD and associated factors are poorly understood. Therefore, it is found to be very important to conduct the study that assess the prevalence and associated factors of CPD at Wachemo University Nigest Elleni Mohammed Memoral Referral Hospital (WCU, NEMMRH), Southern Ethiopia.

Study period, design, and population

The institution-based quantitative cross-sectional study design was conducted at WCUNEMMRH from September-December 2023 G.C. The study was conducted on 384 randomly selected pregnant women attending the delivery ward for the delivery services. All women who have physical deformity on the limbs or other parts that affect anthropometric measurements were excluded from the study.

Sample size determination and sampling procedures

The sample size was determined by using the single population proportion formula. We took the proportion of occurrence of CPD (p₁) = 50%; the proportion of non-occurrence of CPD (p₂) = 50% to maximize sample size. Calculated as follows:

n = (Zα/2)² _x p (1-p)/d²

Where:

n = minimum sample size required for the study

Z = standard normal distribution (Z = 1.96), CI of 95%

d = Absolute precision or tolerable margin of error = 0.05

The overall sample size was 384 pregnant women attending delivery services. To include 384 participants during the study, we used systematic random sampling based on delivery service attendant flow. Averagely, about 20 deliveries occur in the hospital every day; approximately 2400 deliveries occurred in the four months of study period. The calculated ‘K’ that was 6, and the participants were included in every 6th delivery. The first or beginning sample was selected by simple random sampling.

Data Collection Tools, procedure and quality control

The data were collected by using questionnaires and checklists. The questionnaires and checklists were carefully prepared by the investigators by reviewing different related literatures. A pre-test was carried out in 5% of the sample size at Durame General Hospital, which was around 50 km away from the study area, before the actual data collection and adequate modifications were performed based on the pre-test. Gynecologists and obstetricians and midwives were given two-day training concerning the objectives of the study, concepts, approachability, procedures of anthropometric measurements, and ethical issues. Gynecologists and obstetricians performed history taking, physical examinations, diagnoses, and anthropometric measurements by using a weight scale, tape meter, wooden centimeter, and stadiometer. After the assessments were done by the gynecologists and obstetricians the data were carefully filled into questionnaires and checklists by the BSc midwives. The validity, accuracy, consistency, and completeness of the filled data were thoroughly checked on a daily basis. The principal investigator provided a day-to-day on-site supervision during the whole period of data collection.

Maternal height was measured in the standing position following standards of measuring height by using a standardized stadiometer (mothers stood next to a wall with their feet and knees together, knees straight, heels, legs, hips, shoulders, back of the head parallel to the wall, hands hanging on both sides, and looking straight ahead). Lower limb and foot measurements were measured on the right-hand side of the body with a dedicated standardized flexible tape measure.

Measurement and definitions

Abdominal girth measurement: measured with a measuring tape at the level of the umbilicus (16).
Actual birth weight: the weight of the fetus measured immediately after delivery by using a weight scale(17)
Cephalopelvic disproportion (CPD): The failure of the head to descend through the pelvis even with strong uterine contractions and normal presentation and occurs when a baby’s head is too large to fit through the mother’s pelvis or the mother`s pelvis is too small and 1st stage labor stays > 12 hrs for nulliparous women and > 8 hrs for multi-parous women. It can be diagnosed by ultrasound or clinical pelvimetry and written by the physician who performs the surgical procedure (18, 19).
Clinical estimated fetal weight: by using the Insler formula, which is equal to abdominal girth (AG) in centimeters times symphysis fundal height in centimeters (16).
Foot length: is the distance from the longest toe to the back of the calcaneus or heel bone (5).
Hip circumference: it is the length measured at the widest part of the buttocks at the level of prominence of the greater trochanter of the femur at the erected position (20).
Lower limb length: is the distance between the great trochanter and the tip calcaneus bone (heel) (21).
Operative delivery: cesarean section and instrumental delivery.
Spontaneous vaginal delivery: women who gave birth spontaneously through the vaginal canal without the use of forceps or vacuum to assist delivery (19)
Fundal height: is the distance from the symphysis pubis to the point marked of the fundus(16).
Waist circumference: it is a length measured below the lower ribs or halfway between the iliac crest and the lower ribs at an erect position measured after delivery (20)
Waist to Hip ratio: it is the ratio of waist circumference to hip circumference that defines abdominal obesity (20).

Data Processing and Analysis

After the data had been checked for completeness, validity, and consistency, it was entered into Epi-data and then exported to SPSS version 25 for analysis. Descriptive statistics, bivariate, and multivariable logistic regression analyses were performed. Selected variables that have a P-value of ≤ 0.2 at the bivariate analysis were included in the multivariable logistic regression to control all possible confounding factors simultaneously. The goodness of fit was assessed by using the Hosmer and Lemeshow goodness test. Generally, a P-value of ≤ 0.05 was considered statistically significant.

Ethics approval and consent to participate

We followed Declaration of Helinski on human subjects. Ethical clearance was obtained from the Ethical Review Committee of the College of Medicine and Health Sciences, University of Gondar. Permission was obtained from the administration of WCU, NEMMR hospital. A brief explanation of the objectives of the study was given to the participants. Written informed consent was obtained from study participants. Confidentiality was kept carefully by using codes instead of any personal identifiers, and privacy was maintained during the physical examination of each patient.

Socio-demographic characteristics of the participants

Total study participants were 384 women giving birth who participated in the study with a response rate of 100%. Out of 384 women attending birth, two-third (70.83%) were in the 21–30-year age group. About three-fourths (74%) of the participants were rural residents, and the majority (64.58%) of them were housewives. About two-thirds of the study participants were from the Hadiya ethnic group (63.28%), followed by the Silte (17.45%) (Table 1).

Obstetric, gynecologic, and medical variables of the participants

Out of 384 women attending birth, the majority (80.20%) were multigravida. Nearly one of the ten women had a previous history of the cesarean delivery. About 60% of the study participants gave birth after their gestational age was longer than 38 weeks, and 11.72% of them gave neonates weighing greater than 4000 grams. Less than 10 % (7.88% and 7.52%) of the study participants had a history of hypertension and history of diabetes mellitus, respectively. (Table 2)

Maternal anthropometry of the participants

Out of the 384 study participants, about one third (34.90%) of them were underweight. From the study participants, nine of the hundred women had short stature (≤ 150 cm tall). (Table 3)

Mean values of the some continues variables

The mean age of CPD women was 29.28 years: those of non-CPD was 27.82 years. The mean GA of CPD and non CPD group was 39.28 and 38.83 weeks, respectively. The mean maternal height was in CPD group 157.3 cm and 160.4 cm in non-CPD group. The mean maternal lower limb extremity in CPD group were 84.6 cm and in non-CPD group was 85.77 cm. The mean maternal foot length 25.13 cm in CPD group and 27 cm in non CPD group. The mean abdominal girth in CPD group were 103.2 cm and 99.24 in non-CPD group. The mean fundal height in CPD group were 39.06 cm and 37.7 cm in non CPD group. The mean waist hip ratio in CPD group was 0.85; in non CPD group was 0.86. The mean fetal birth weight in CPD group was3996 gm; and in non CPD was 3471 gm. The mean fetal head circumference in CPD group was 40.7 cm and in non-CPD group was 36.9 cm. (Figure 1)

Associated factors of CPD

On bivariate analysis, age, parity, maternal height, history of the hypertension, history of diabetes mellitus, previous history of the cesarean delivery, actual fetal weight, abdominal girth, waist hip ratio, and fetal head circumference were significantly associated with CPD. These all variables were put into multivariable logistic regression analysis to simultaneously control the confounders. As a result, maternal height, history of diabetes mellitus, previous history of the cesarean delivery, actual fetal weight, and fetal head circumference were significantly associated with CPD.

Accordingly, the decrease in one centimeter of the maternal height triples the chance of the developing the CPD [AOR=3 (95% CI: 1.76-5.24)]. The women a having history of diabetes mellitus were 2.8 times [AOR=2.8 (95% CI: 1.17-5.32)] more likely to develop CPD when compared to their counterparts. One gram increment in fetal weight increases the chance of developing CPD by the 3.5 folds [AOR=3.8 (95% CI: 1.12-5.88)]. A unit increment in fetal head circumference doubles the likelihood of the developing the CPD [AOR=2 (95% CI: 1.47-4.95)]. (Table 4)

This study primarily assessed prevalence, maternal anthropometries, pelvimetries, and other associated factors of CPD at WUC, NEMMRH, Southern Ethiopia. Accordingly, maternal height, history of diabetes mellitus, actual fetal birth weight, and fetal head circumferences were significantly associated with CPD.

This study’s findings showed that the prevalence of CPD was 13.8% which is consistent with other study reports (11.3%) conducted in Ethiopia (22) and (11.3%) conducted in Nigeria (23). However, this magnitude is considerably higher than systematic review reports (8.45%) from Ethiopia (24), and the other systematic review report (6.5%) in four East Asia countries (25). This discrepancy is probable because of different in study methodology, because systematic reviews involved very wide geographic areas, a wide range of socioeconomic characteristics, different levels of health setups, and differences in the diagnostic criteria of CPD. In our study, during the study period, out of 76 mothers were indicated to CS delivery secondary to obstructed labor. Among these, the majority (69.9%) of obstructed labor was secondary to cephalopelvic disproportion. This finding is supported with the figures from other study reports (64%) from the Ethiopia (22, 24).

Current study maternal height was associated with the CPD. The decrease in one centimeter of the maternal height triples the chance of developing the CPD. This finding is in agreement with a study conducted in Ireland, which found that a 1 cm increment in maternal height resulted in a nine times decrease in the occurrence of CPD (26) and studies conducted in Rwanda and India revealed that maternal height was significantly associated with the occurrence of CPD (10, 19). As several studies agreed, in Ethiopia in general and in the study area in particular, malnutrition would affect fetal growth, childhood body growth, and maternal pelvic development that results in short stature, which potentially leads to higher rates of CPD. (27, 28). Moreover, malnutrition can lead to other complications during pregnancy, such as preterm birth or low birth weight, which may indirectly affect the dynamics of labor and delivery. Furthermore, malnutrition has more deeply rooted multidimensional complex adverse outcomes that impact the productivity of the country (27, 29). Therefore, addressing malnutrition through proper and adequate nutrition is crucial for reducing the risks associated with CPD and ensuring better outcomes for both mother and child.

In this study, one gram increment in fetal weight increases the chance of developing CPD by 3.5 folds. This finding is supported by the study reports from Ethiopia (30) and Nigeria (23). An increased fetal birth weight is associated with the high risk of mortality and morbidity in neonates as well as in their mothers. The larger fetal size is related with genetic predisposition, maternal health conditions like diabetes mellitus, obesity, and polyhydramnios. Moreover, larger fetal weight can complicate labor dynamics, making it more difficult for the baby to navigate through the birth canal, potentially leading to prolonged labor or other complications (31). Therefore, it is very important to monitor fetal birth weight through the proper dietary practices, controlling maternal blood sugar, doing regular physical exercise, and completing ANC fellow-up.

In this finding, head circumference of the newborn was significantly associated with CPD). A unit increment in fetal head circumference doubles the likelihood of the developing the CPD. This finding is in line with studies conducted in Ireland and Iran (12, 35). The fetal head circumference may be or may not be related to a large fetal size. The fetal head circumference is a crucial measurement in assessing the potential for CPD. The CPD occurs when the baby's head or body is too large to fit through the mother's pelvis during delivery. The fetal head circumference is a vital measurement in evaluating the risk of CPD (32). Monitoring this parameter, along with maternal pelvic anatomy and other factors, helps healthcare providers make informed and planned decisions regarding delivery management to ensure the safety of both mother and baby.

In a recent study, maternal diabetes mellitus is significantly associated with CPD. This finding is supported by the recent finding report of the systematic review among Sub-Saharan countries (33). Maternal diabetes mellitus can have several implications for pregnancy and delivery, one of which is the potential for CPD. The high blood sugar levels can lead to excessive fetal growth, which leads to a higher likelihood of obstructed labor and its complications (31, 33). Healthcare providers monitor pregnancies with maternal diabetes closely and consider early delivery (induction or cesarean) if there are concerns about fetal size and the potential for CPD.

As a strength, this study tried to reduce bias by randomizing the selection of study participants. We also reduced confounder bias during analysis. For example; lower limb length, and foot length showed a confounder effect with maternal height. As a limitation, this study was hospital-based and it lacks generalizability to the community at large. Also, we could not assess internal pelvimetries, which are more direct and reliable.

In conclusion, CPD is a significant obstetric condition that can complicate labor and delivery. The prevalence of CPD in WCU, NEMMRH, southern Ethiopia is 13.8%. Maternal stature, maternal diabetes mellitus, fetal birth weight, and fetal head circumferences are significantly associated with CPD. As a recommendation, we suggest preconception and postconception nutritional counseling, improving childhood nutrition, monitoring during pregnancy, maternal glycemic control, and planning for labor management.

ABW Actual Birth Weight

AG Abdominal Girth

AOR Adjusted Odds Ratio

BMI Body Mass Index

CI Confidence Interval

COR Crude Odds Ratio

CPD Cephalopelvic Disproportion

CS Caesarean Section

DM Diabetes Mellitus

EFW Estimated Fetal Weight

IUFD Intra Uterine Fetal Death

LNMP Last Normal Menstrual period

WCUNEMMRH Wachemo University Nigist Elleni Memorial Referral Hospital

OL Obstructed Labor

SPSS Statistical Package of Social Science

UNFPA United Nations Fund for Population Activities

UNICEF United Nations International Children’s Emergency Fund WHO World Health Organization

WHR Waist to Hip Ratio

Acknowledgements

We would like to pass our deepest gratitude to the Ethical Review Committee of College of Medicine and Health Sciences, University of Gondar, for giving ethical clearance. Also, our thanks would be to hospital manager, data collectors, and study participants for their commitment during data collection.

Author contributions

AB, DE, YA, and KK participated in the conceptualization, formal analysis, investigation, methodology, supervision, visualization, writing-original draft, writing-review and editing, and approving the final draft. All authors read and approved the manuscript.

Consent for publication

Not applicable

Availability of data and materials

The data sets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Competing interests

The authors declare that they have no competing interests.

Funding

The Authors declare that no funding received.

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Table 1

Sociodemographic characteristics of the participants attending delivery ward at WCU, NEMMRH, 2023
Variables		CPD		Total	Percentage (%)
Variables		No	Yes	Total	Percentage (%)
Age of the participants (in years)	<=20	9	4	13	3.39
	21–30	235	35	272	70.83
	31–40	81	15	96	25.00
	> 40	2	1	3	0.78
Residence of the participants	Rural	244	40	284	74
Residence of the participants	Urban	87	13	100	26
Occupation of the participants	Housewife	215	33	248	64.58
	Governmental employee	58	4	62	16.15
	Non-governmental employee	36	7	43	11.20
	Others	22	9	31	8.07
Ethnicity of the participants	Hadiya	206	37	243	63.28
	Silte	62	5	67	17.45
	Kambata	39	7	46	11.98
	Gurage	17	3	20	5.21
	Others	7	1	8	2.08

Table 2

Obstetric, gynecologic, and medical variables of the participants attending delivery ward at WCU, NEMMRH, 2023
Variables		Cephalopelvic disproportion		Total	Percentage (%)
Variables		No	Yes	Total	Percentage (%)
Parity	Multigravida	266	42	308	80.20
Parity	Primigravida	65	11	76	19.80
History of treatment for fertility	No	321	49	370	96.35
History of treatment for fertility	Yes	10	4	14	3.65
Previous history of the cesarean delivery	No	309	40	349	90.88
Previous history of the cesarean delivery	Yes	22	13	35	9.12
Sex of the new born	Female	162	26	188	48.96
Sex of the new born	Male	170	27	190	51.04
Mode of delivery	SVD	242	0	242	63.02
	AVD	48	6	54	14.06
	CS	41	47	88	22.92
Polyhydramnios	No	315	51	366	95.31
Polyhydramnios	Yes	16	2	18	4.69
Gestational age in weeks	<=38	141	10	151	39.32
Gestational age in weeks	> 38	190	43	233	60.68
Actual fetal weight in grams	<=4000	312	27	339	88.28
Actual fetal weight in grams	> 4000	19	26	45	11.72
Fetal head circumference	<=38cm	218	13	231	60.16
Fetal head circumference	> 38 cm	113	40	153	39.84
History of hypertension	No	307	47	354	92.12
History of hypertension	Yes	24	6	30	7.88
History of diabetes mellitus	No	311	45	355	92.48
History of diabetes mellitus	Yes	20	8	28	7.52

Table 3

Maternal anthropometry of the participants attending delivery ward at WCU, NEMMRH, 2023
Variables		CPD		Total	Percentage (%)
Variables		No	Yes	Total	Percentage (%)
Maternal height	≤ 150 cm	11	23	34	8.85
Maternal height	> 150 cm	320	30	350	91.15
BMI (k/m²)	18.5–25	216	44	250	65.10
BMI (k/m²)	< 18.5	115	9	124	34.90
Maternal foot length	≤ 26 cm	165	29	194	50.52
Maternal foot length	> 26 cm	166	24	190	49.48
Maternal lower limb length	≤ 86 cm	162	26	188	48.96
Maternal lower limb length	> 86 cm	172	24	196	51.04
Hip circumference	≤ 90cm	200	30	230	60.00
Hip circumference	> 90 cm	131	23	154	40.00
Abdominal girth	≤ 100 cm	228	32	260	67.70
Abdominal girth	> 100 cm	103	21	124	32.40
Fundal height	≤ 38 cm	217	21	238	62.00
Fundal height	38 cm	114	32	146	38.00
Waist circumferences	≤ 84 cm	186	26	212	56.51
Waist circumferences	> 84 cm	145	27	172	43.49
Waist hip ratio	< 0.86 cm	182	30	212	55.21
Waist hip ratio	≥ 0.86 cm	149	23	172	54.79

Table 4

Logistic regression analyses on associated factors of CPD among the study participants attending delivery ward at WCU, NEMMRH, 2023
Variables		Cephalopelvic disproportion		Total	COR(CI)	AOR(CI)	P value
Variables		No (331)	Yes (53)	Total	COR(CI)	AOR(CI)	P value
Age of the participants (in years)	<=20	9	4	13	1	1	-
	21–30	235	35	272	1.83 (0.33–4.50)	1.53(0.23–14.50)	0.23
	31–40	81	15	96	2.22(0.39–8.38)	2.81(0.27–8.38)	0.46
	> 40	2	1	3	4.8(0.41–40.05)	6(0.41-102.05)	0.51
Parity	Multigravida	266	42	308	1	1
Parity	Primigravida	65	11	76	0.8(0.58–1.09)	0.36(0.15–1.06)	0.06
Maternal height in cm	-	331	53	384	4(1.32–2.82)	3(1.76–5.24)	0.00
History of hypertension	No	307	47	354	1
History of hypertension	Yes	24	6	30	0.61(0.24–1.34)	0.82(0.44–2.44)	0.32
History of diabetes mellitus	No	311	45	355	1	1
History of diabetes mellitus	Yes	20	8	28	3.7(1.15–5.64)	2.8(1.17–5.32)	0.03
Previous history of the cesarean delivery	No	309	40	349	1	1
Previous history of the cesarean delivery	Yes	22	13	35	2(2.13–7.76)	3.5(0.93–7.23)	0.07
Actual fetal weight in grams	331	53	384	331	5(1.82–6.22)	3.8(1.12–5.88)	0.01
Sex of the new born	Female	162	26	188	1	1
Sex of the new born	Male	170	27	190	1.22(0.68–2.81)	1.42(0.32–3.31)	0.14
Abdominal girth	331	53	384	331	1.45(1.8–2.64)	1.9(0.90–4.68)	0.52
Waist hip ratio	331	53	384	331	0.93(0.52–1.68)	0.84(0.44–1.87)	0.21
Fetal head circumference	331	53	384	331	2.4(1.30–3.65)	2(1.47–4.95)	0.01

No competing interests reported.

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Prevalence, and Associated Factors of Cephalopelvic Disproportion Among Pregnant Women Attending Delivery Services at Wachemo University, Nigist Elleni Mohammed Memorial Referral Hospital, Southern Ethiopia

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Abstract

Introduction:

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Results

Conclusion

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Introduction

Methods and materials

Study period, design, and population

Sample size determination and sampling procedures

Data Collection Tools, procedure and quality control

Measurement and definitions

Data Processing and Analysis

Ethics approval and consent to participate

Results

Socio-demographic characteristics of the participants

Obstetric, gynecologic, and medical variables of the participants

Maternal anthropometry of the participants

Mean values of the some continues variables

Associated factors of CPD

Discussion

Conclusions and recommendations

Abbreviations

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Tables

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