Jean-Baptiste KakomaLubumbashi University and Rwanda University , Democratic Republic of Congo
Title: External clinical pelvimetry as a tool for the prevention of obstetric fistulas in nulliparous women in a setting with limited resources
Pregnant women, especially nulliparae in countries with limited resources, do not benefit from appropriate assistance during prenatal visits and childbirth, resulting in a high prevalence of maternal and perinatal morbi-mortality. Obstetric fistulas resulting from obstructed labour, due to poorly assisted deliveries or not at all, represent one of the most debilitating conditions as far as future reproductive capacity and life in society for desperate young mothers are concerned. Although external pelvimetry, once commonly practiced by old obstetricians, is strongly denigrated nowadays, several studies carried out in Central Africa, and especially in DR Congo (Lubumbashi) and Rwanda (Huye and Kigali), have shown a highly significant difference between external pelvic diameters of pregnant women giving birth vaginally and those of caesarean sections, and a highly significant correlation between pelvic dimensions and rates of caesarean sections with regard to obstructed labour as an indication. The pelvic diameters involved were: intercrestal, interspinous, intertrochanteric, intertuberous, anteroposterior and Base of the Trillat's triangle. The critical cutoff sizes of these diameters included in a score were thus defined and are already used successfully as elements of indication for planned caesarean section in nulliparous women with a strong suspicion of a generally contracted pelvis during antenatal clinic or just on admission to the labor room. However, to improve the predictive values ??of this score, we are planning a study involving a larger sample and taking into account an essential fetal factor in the event of cephalopelvic disproportion, i.e. the fetal head whose perimeter has shown a strong correlation with fundal height, which is accessible and will be integrated among the parameters constituting the predictive score. Thus, the external pelvimeter, a very simple tool could prove to be highly useful for the prevention of obstetric fistulas in our environment, thanks to a caesarean scheduled at the right time.
Jean-Baptiste Kakoma was trained at Lovanium University in Kinshasa (DRC), the Catholic University of Louvain and the Institute of Tropical Medicine Antwerp (Belgium). He has been since 1987 professor of Obstetrics and Gynecology, Public Health, Demography and Parasitology at the University of Kisangani and the University of Lubumbashi in DR Congo, the National University of Rwanda and the University of Rwanda College of Medicine and Health Sciences / Schools of Public Health and Medicine. As an experienced health professional, university teacher, researcher, and administrator, he has a combination of practice, leadership, research, and management skills. He thus held important academic and managerial positions for more than 30 years (head of department, director of university clinics, dean of school of medicine and school of public health, director of research center and university vice-chancellor). He has trained thousands of medical doctors, hundreds of medical specialists and dozens of PhD holders. He has published many scientific articles and written more than ten books and book chapters. As Emeritus Professor, he devotes his time to the training of specialists and doctoral students in medicine and public health in the Democratic Republic of Congo and Rwanda.