A safe, low-cost, easy-to-use 3D camera platform to assess risk of obstructed labor due to cephalopelvic disproportion

PLoS One. 2018 Sep 14;13(9):e0203865. doi: 10.1371/journal.pone.0203865. eCollection 2018.

Abstract

Cephalopelvic disproportion (CPD)-related obstructed labor is accountable for 3-8% of the maternal deaths worldwide. The consequence of CPD-related obstructive labor in the absence of a Caesarian section (C/S) is often maternal or perinatal mortality or morbidity to the mother and/or the infant. Accurate and timely referral of at-risk mothers to health facilities where C/S is a delivery option could reduce maternal mortality in the developing world. The goal of this work was to develop and test the feasibility of a safe, low-cost, easy-to-use, portable tool, using a Microsoft Kinect 3D camera, to identify women at risk for obstructed labor due to CPD. Magnetic resonance imaging (MRI) scans, 3D camera imaging, anthropometry and clinical pelvimetry were collected and analyzed from women 18-40 years of age, at gestational age ≥36+0 weeks with previous C/S due to CPD (n = 43), previous uncomplicated vaginal deliveries (n = 96), and no previous obstetric history (n = 148) from Addis Ababa, Ethiopia. Novel and published CPD risk scores based on anthropometry, clinical pelvimetry, MRI, and Kinect measurements were compared. Significant differences were observed in most anthropometry, clinical pelvimetry, MRI and Kinect measurements between women delivering via CPD-related C/S versus those delivering vaginally. The area under the receiver-operator curve from novel CPD risk scores base on MRI-, Kinect-, and anthropometric-features outperformed novel CPD risk scores based on clinical pelvimetry and previously published indices for CPD risk calculated from these data; e.g., pelvic inlet area, height, and fetal-pelvic index. This work demonstrates the feasibility of a 3D camera-based platform for assessing CPD risk as a novel, safe, scalable approach to better predict risk of CPD in Ethiopia and warrants the need for further blinded, prospective studies to refine and validate the proposed CPD risk scores, which are required before this method can be applied clinically.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Anthropometry / methods
  • Cephalopelvic Disproportion / diagnostic imaging*
  • Cesarean Section
  • Delivery, Obstetric / methods
  • Ethiopia
  • Female
  • Humans
  • Imaging, Three-Dimensional / methods
  • Magnetic Resonance Imaging
  • Maternal Mortality
  • Middle Aged
  • Obstetric Labor Complications
  • Pelvimetry / methods*
  • Pregnancy
  • Prospective Studies
  • Risk Assessment / methods*
  • Risk Factors
  • Young Adult

Grants and funding

We gratefully acknowledge the support from Grand Challenges Canada (Grant Number 0748-03, RLG), as part of the Saving Lives at Birth Partnership (https://savinglivesatbirth.net/) between the United States Agency for International Development (USAID), Norwegian Agency for Development Cooperation (Norad), Bill & Melinda Gates Foundation, Grand Challenges Canada, UKaid, and the Korea International Cooperation Agency (KOICA). We also gratefully acknowledge the support from US State Department, Bureau of Educational and Cultural Affairs, Fulbright Scholars Program (Grant ID: 48153580, RLG, http://www.cies.org/). LymphaTech Inc. provided support in the form of salaries for authors MW and NF, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.