FACTORS ASSOCIATED WITH CONTRACTED PELVIS IN WOMEN DELIVERING

IN BANADIR HOSPITAL IN MOGADISHU SOMALIA

CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND OF THE STUDY
Contracted pelvis a pelvis that is abnormally small in one or more principal diameters and
that consequently interferes with normal childbirth.
Globally, obstructed labour is one of the major causes of maternal as well as perinatal
mortality and morbidity. It also causes significant maternal morbidity in the short term
(notably infection) and long term (notably obstetric fistulas). It has been defined as ‘Failure
of descent of the foetus in the birth canal for mechanical reasons in spite of good uterine
contractions.3 One of the major causes for this is severely contracted pelvis often a result of
childhood malnutrition. Osteomalacic pelvis is a type of contracted pelvis with metabolic
aetiology. The various factors responsible for osteomalacic pelvis are inadequate dietary
calcium and vitamin ‘D’, closely spaced pregnancies and prolonged lactation, diet of
unleavened wheat flour and Purdah system. Pakistan reported 2% prevalence of osteomalacia
in all obstetric patients from 1978-1985, of which 37% (22) exhibited CPD, nearly half of
which (46%) were due to osteomalacia.6 The course of the disease is gradual with initial
symptoms of backache, pain in limbs, muscular weakness, nervousness and tetany. During
subsequent pregnancy symptoms return with increased severity giving rise to forward jutting
of symphysis pubis with reduced conjugate diameter. Sinking of trunk leads to short stature
and narrowing of bony canal leads to contracted pelvis and ultimately obstructed labour. This
case is presented here to discuss the potential role of nutrition and calcium supplementation
to prevent osteomalacia.
In Uganda the early years the degree of contraction was so great that the patients could only
be described as being deformed rachitic dwarfs. Even twenty-five years ago the degree of
pelvic contraction was often extreme. In the past twenty-five years, however, there has been a
noticeable and marked improvement in the degree of contraction ( D'Esopo ,1999).
None the less, the cases of contracted pelvis which occur and with which we are concerned
to-day are classified as such by generally recognized standards. The contracted pelvis is
defined anatomically by being a pelvis in which one or more of its main diameters is reduced
below average normal by one or more cm. Whereas obstetricians tend to define it as the
pelvis in which one or more of its main diameters are reduced to the extent that interferes
with the normal mechanism of labour i.e spontaneous vaginal delivery.
 FACTORS ASSOCIATED WITH CONTRACTED PELVIS IN WOMEN DELIVERING
IN BANADIR HOSPITAL IN MOGADISHU SOMALIA

In no case, for instance, was the true conjugate diameter at the brim more than 10 cm. Where
it was as high as 10 cm. there was always other evidence of pelvic contraction, either in the
cavity or at the outlet, before it was regarded as contracted. Although the grosser
manifestations of rickets are now a comparative rarity. The severity of rickets in the past so
affected the pelvic brim that the importance of flat pelves overshadowed other less striking
pelvic deformities ( Caldwell and Moloy ,1933).
To-day gross flattening is uncommon, and contraction in any pelvic plane can arise in a
haphazard fashion which defies strict morphological classification. Thus the classifications of
Caldwell and Moloy (1933), of D'Esopo (1949), of Thoms (1935), and of other Americans,
which have been so helpful in the study of congenital pelvic anomalies, are much less helpful
in cases in which the contraction is due to pathological bony development.
With the reduction in the number of cases of severely contracted pelvis, we encounter new
difficulties in diagnosis and new problems in management. I have stressed the importance of
this elsewhere (MacLennan, 1944).
In East Africa especially Somalia there is no published data about prevalence and factors
associated with contracted pelvis.
1.2 PROBLEM STATEMENT
Globally, obstructed labour is one of the major causes of maternal as well as perinatal
mortality and morbidity.
In the past twenty-five years Somalia's maternal mortality ratio is increasing, making it one of
the highest in the world and contributes to raising the regional and global averages for the
indicator.
Moreover, reproductive health situation analysis conducted by UNFPA in early 2009
concluded that more than 90% of women deliver at home as more than half are assisted by
traditional birth attendants (TBAs) (UNFPA 2012).
In spite of these, Contracted pelvis has not been acknowledged as a priority health issue for a
long time.
Health system factors especially in rural areas like inadequate facilities and a poor referral
system, inadequate skilled staff to handle Delivery, low awareness of the problem of
Contracted pelvis at the community level and cultural practices such as early marriages and
pregnancies increases women‟s vulnerability to sustaining it (UNFPA 2012).
The study therefore will focus on the factors associated with contracted pelvis in women
delivering in Banadir Hospital.
 FACTORS ASSOCIATED WITH CONTRACTED PELVIS IN WOMEN DELIVERING
IN BANADIR HOSPITAL IN MOGADISHU SOMALIA

1.3 THE PURPOSE OF THE STUDY

The purpose of the study will focus the factors associated with contracted pelvis in women
delivering in Banadir Hospital in Mogadishu somalia using cross sectional survey conducting
in the year 2018.

1.4 RESEARCH QUESTIONS

1. What are the factors contributing to contracted pelvis among women delivering in
Banadir Hospital in Mogadishu - Somalia?

1.5 RESEARCH OBJECTIVES

1. To identify the social and economic factors associated with contracted pelvis among
women delivering in Banadir Hospital in Mogadishu - Somalia.
2. To investigate the socio demographic factors contributing to the contracted pelvis
among women delivering in Banadir Hospital, in Mogadishu - Somalia.

1.6 SCOPE OF THE STUDY

1.6.1 Time Scope

This is study will be conducted from August 2018 to November 2018

1.6.2 Geographic scope

The research area was based in Banadir Hospital in Mogadishu Somalia

1.6.3 Content scope

The research contents was to study the factors associated with contracted pelvis in women
delivering in Banadir Hospital in Mogadishu Somalia

1.7 SIGNIFICANCE OF THE STUDY

This study will help analyze the extent of the problems of contracted pelvis In Hospitals. It
will also contribute to the epidemiological data of the contracted pelvis at the selected
Hospitals and serve as a base for future research. In addition, the factors that will be
 FACTORS ASSOCIATED WITH CONTRACTED PELVIS IN WOMEN DELIVERING
IN BANADIR HOSPITAL IN MOGADISHU SOMALIA

discovered in this study will be used as part of medical policies, and it will also help with the
prevention process of the hospitals both national and international.

1.8 OPERATIONAL DEFINITION

The contracted pelvis is defined anatomically by being a pelvis in which one or more of its
main diameters is reduced below average normal by one or more cm. Whereas obstetricians
tend to define it as the pelvis in which one or more of its main diameters are reduced to the
extent that interferes with the normal mechanism of labour i.e spontaneous vaginal delivery.

1.9 Conceptual Framework

Demographic Factors

Contracted Pelvis
Socio Economic Factors Among Women
Delivering In
Banadir Hospital

Add Growth Factors