[Dystocia: frequency and risk factors in seven areas in West Africa]

1) To measure the incidence of dystocia in six cites and one rural area in West Africa. 2) To identify risk factors of dystocia and analyze their interrelationships with the goal to potentially use them to identify high-risk pregnant women attending antenatal consultations. (3) To assess their usefulness as predictors of dystocia during pregnancy.

The MOMA study is a prospective population-based follow-up study of 20,326 pregnant women in West Africa. Due to the likely diagnostic and recall bias for home deliveries, risk factors for dystocia were analyzed only for deliveries in health facilities. A total of 16,318 deliveries were analyzed.

The incidence of dystocia was 18.3% (95%CI: 17.7-18.9). Multivariate analysis using stepwise logistic regression disclosed the following significant risk factors: short stature, scarred uterus, nulliparity. Positive predictive values were very low for both univariate and multivariate analysis.

The incidence of dystocia, which occurs mainly at delivery, is high in West Africa. Consequences are often dramatic, both for the fetus and the mother. None of the risk factors studied, even when used in combination, provided a good prediction of dystocia. All pregnant women should therefore be considered at risk of dystocia. Efforts should be made to detect dystocia during labor (partography) and to provide good-quality emergency obstetric care. Emergency obstetric care must be made available to all pregnant women. This goal can be achieved in most of the major West African cities. More facilities offering good-quality cesarean section must be made available.