hospital settings in Spain, United States, and South Africa.
X‐ray pelvimetry
no X‐ray pelvimetry in cephalic presentations
1 Most studies contributing data had design limitations. Two studies had serious design limitations (high risk of bias for sequence generation and allocation concealment) one of which contributed 37.4% of weight (‐2).
2 Most studies contributing data had design limitations. (‐1)
3 Wide confidence interval crossing the line of no effect, small sample size, few events and lack of precision. (‐2)
4 One study contributing data with serious design limitations. (‐2)
5 Very wide confidence intervals crossing the line of no effect, small sample size and few events. (‐2)
6 Study contributing 79.7% total weight has serious design limitations. (‐2)
All five trials assessed the rate of caesarean section as an outcome, including a total of 1159 women. Crichton 1962 reported caesarean section and symphysiotomy results combined, therefore data for both caesarean section and symphysiotomy are included in this analysis. No other study reported symphysiotomy.
Women who had X‐ray pelvimetry had a higher rate of caesarean section than those women who had no X‐ray pelvimetry. The risk ratio (RR) for caesarean section is 1.34 (95% confidence interval (CI) 1.19 to 1.52; 1159 women; 5 trials; low‐quality evidence ) Analysis 1.1 when compared to women who did not get an X‐ray pelvimetry. Quality of evidence as assessed using GRADE is low.
Comparison 1: X‐ray pelvimetry versus no X‐ray pelvimetry, Outcome 1: Caesarean section
Subgroup interaction tests suggest no clear differences in effects for women with previous versus women with no previous caesarean section (Test for subgroup differences: Chi² = 1.52, df = 1 (P = 0.22), I² = 34.1%). The two trials that only included women with a previous section ( Richards 1985 ; Thubisi 1993 ), performed elective caesarean sections on the women whose pelvic inlets did not satisfy pre‐specified requirements following antenatal X‐ray pelvimetry; all those who did satisfy requirements were left to go into spontaneous labour. A higher caesarean rate might therefore be expected. In future updates of this review it will be useful to analyse data for rates of elective and emergency caesarean sections separately.
All five trials assessed the perinatal mortality as an outcome, including a total of 1159 women. There is no clear difference in perinatal mortality between women who did and women who did not receive an X‐ray pelvimetry (RR 0.53, 95% CI 0.19 to 1.45; 1159 infants; 5 trials; very low‐quality evidence ) Analysis 1.2 . Quality of evidence as assessed using GRADE is very low.
Comparison 1: X‐ray pelvimetry versus no X‐ray pelvimetry, Outcome 2: Perinatal mortality
One trial including 288 women who all had a previous caesarean ( Thubisi 1993 ) assessed the incidence of puerperal pyrexia as an outcome after caesarean in both groups (women who did receive an X‐ray pelvimetry compared to women who did not). Little difference was found: RR 0.80 (95% CI 0.22 to 2.92; 288 women; 1 trial) Analysis 1.3 .
Comparison 1: X‐ray pelvimetry versus no X‐ray pelvimetry, Outcome 3: Puerperal pyrexia
One trial including 288 women ( Thubisi 1993 ) assessed the incidence of wound sepsis as an outcome after caesarean in both groups (women who did receive an X‐ray pelvimetry compared to women who did not). Little difference was found: RR 0.83 (95% CI 0.26 to 2.67; 288 women; 1 trial; very low‐quality evidence ) Analysis 1.4 . Quality of evidence as assessed using GRADE is very low.
Comparison 1: X‐ray pelvimetry versus no X‐ray pelvimetry, Outcome 4: Wound sepsis
One trial including 288 women ( Thubisi 1993 ) assessed the need for blood transfusion as an outcome in both groups (women who did receive an X‐ray pelvimetry compared to women who did not). No difference was found: RR 1.00 (95% CI 0.39 to 2.59; 288 women; 1 trial; very low‐quality evidence ) Analysis 1.5 . Quality of evidence as assessed using GRADE is very low.
Comparison 1: X‐ray pelvimetry versus no X‐ray pelvimetry, Outcome 5: Blood transfusion
Two trials including 390 women ( Richards 1985 ; Thubisi 1993 ) assessed the incidence of scar dehiscence as an outcome in women who had one previous transverse uterine segment caesarean section and underwent trial of scar. Little difference was found: RR 0.59 (95% CI 0.14 to 2.46; 390 women; 2 trials; v ery low‐quality evidence ) Analysis 1.6 . Quality of evidence as assessed using GRADE is very low.
Comparison 1: X‐ray pelvimetry versus no X‐ray pelvimetry, Outcome 6: Scar dehiscence
One trial including 305 infants ( Crichton 1962 ) assessed incidence of perinatal asphyxia. Little difference was found: RR 0.66 (95% CI 0.39 to 1.10; 305 infants; 1 trial) Analysis 1.7 .
Comparison 1: X‐ray pelvimetry versus no X‐ray pelvimetry, Outcome 7: Perinatal asphyxia
One trial including 288 infants ( Thubisi 1993 ) assessed the need for admission to a special care baby unit. Little difference was found: RR 0.20 (95% CI 0.01 to 4.13; 288 infants; 1 trial; very low‐quality evidence ) Analysis 1.8 . Quality of evidence as assessed using GRADE is very low.
Comparison 1: X‐ray pelvimetry versus no X‐ray pelvimetry, Outcome 8: Admission to special care baby units
No trials assessed the Apgar score less than seven at five minutes as an outcome.
Three trials included women with no previous caesarean section ( Crichton 1962 ; Gaitan 2009 ; Parsons 1985 ) with a total number of 769 women. There is a higher caesarean section rate (and symphysiotomy rate in Crichton 1962 ) in the X‐ray pelvimetry group (RR 1.24, 95% CI 1.02 to 1.52; 769 women; 3 trials). There is no difference in perinatal mortality (RR 0.64, 95% CI 0.21 to 1.90; 769 women; 3 trials). There was a slight decrease in perinatal asphyxia and perinatal mortality in Crichton 1962 , but this decrease in perinatal mortality was not observed in Parsons 1985 or Gaitan 2009 . Neither trial reported perinatal asphyxia. The decrease seen in Crichton 1962 could be due to chance or lack in fetal monitoring. None of these trials reported puerperal pyrexia, wound sepsis, blood transfusion, or admission to special care baby unit. Scar dehiscence was not relevant to these women.
Two trials included women who had a previous transverse lower segment caesarean section ( Richards 1985 ; Thubisi 1993 ), with a total number of 390 women. There was an overall increase in the caesarean section rate in both studies in the X‐ray pelvimetry groups (RR 1.45, 95% CI 1.26 to 1.67; 390 women; 2 trials). There was a slight decrease in perinatal mortality, which could have occurred by chance, in Richards 1985 , but this was not observed in Thubisi 1993 where there were no perinatal deaths in either group (RR 0.19, 95% CI 0.01 to 3.91; 390 women; 2 trials). There were similar rates of scar dehiscence in the intervention and control groups (RR 0.59, 95% CI 0.14 to 2.46; 390 women; 2 trials). Thubisi 1993 reported a slight increase in admissions to special care baby units in the control group, but again these could have occurred by chance. Richards 1985 did not report this outcome. Only Thubisi 1993 reported puerperal pyrexia, wound sepsis and blood transfusion and did not find any difference between the groups.
We carried out sensitivity analysis for lack of allocation concealment. Parsons 1985 and Thubisi 1993 were assessed to be at high risk of selection bias and were removed from Analysis 1.1 : Caesarean section/symphysiotomy and Analysis 1.2 : Perinatal mortality. There were not sufficient data to remove these trials from the other outcomes and maintain a meaningful analysis.
For the outcome caesarean section/symphysiotomy, removing the trial data widened the CIs and lessened the effect slightly (RR 1.25, 95% CI 1.04 to 1.49), but the data still showed that women who had pelvimetry were more likely to have a caesarean section. Regarding the women without a previous caesarean section, removing Parsons 1985 meant that the CIs crossed the line of no effect (RR 1.19, 95% CI 0.96 to 1.47).
There were no perinatal deaths in either Parsons 1985 or Thubisi 1993 , so removing the data from the meta‐analysis made no difference to the overall relative risk.
X‐ray pelvimetry versus no pelvimetry or clinical pelvimetry is the only comparison included in this review due to the lack of trials identified that used other types of pelvimetry (other radiological examination).
Five trials with a total of 1159 women were included. All used X‐ray pelvimetry to assess the pelvis. X‐ray pelvimetry versus no pelvimetry or clinical pelvimetry is the only comparison included in this review due to the lack of trials identified that used other types or pelvimetry.
Women who received an X‐ray pelvimetry, had a higher risk having a caesarean section, without a decrease in perinatal mortality. The control groups tended to a slightly raised perinatal mortality, but this could be due to chance. The numbers studied were insufficient to assess perinatal mortality adequately. No clear differences were found between groups for puerperal pyrexia, wound sepsis, blood transfusion, scar dehiscence, perinatal asphyxia or admission to special care baby unit. No trial reported Apgar score less than seven at five minutes.
Parsons 1985 explains the increased perinatal mortality and asphyxia in Crichton 1962 by the lack of electronic fetal monitoring available to the women in Crichton's trial. The two deaths in the study of Richards 1985 occurred in utero before the onset of labour.
Some of the outcomes in this review, relating to women with a previous caesarean, are difficult to interpret because they are mediated by another outcome, for example, wound sepsis and blood transfusion are only relevant to those women who have a caesarean section.
The trials are compatible with respect to the common measures of outcome. The small number of trials included in this review address the research question and do not support the use of X‐ray pelvimetry, though they are of low quality, and there are no trials to assess the use of computed tomography (CT) or magnetic resonance imaging (MRI) pelvimetry. The paucity of trials assessing the effectiveness of all methods of pelvimetry, for both women with and without a previous caesarean, limits the applicability of this review. The majority of the few trials available are over 20 years old. This perhaps reflects how little pelvimetry is used by clinicians in current practice.
The trials were also conducted in a small number of countries (South Africa, Spain, and the USA) and therefore the findings may not be applicable to low‐income settings.
All trial designs regarding treatment allocation were of poor quality, assessed as high or unclear risk of bias. None of the trials blinded participants, staff or outcome assessors. The trials were not well‐reported so it was difficult to assess the other 'Risk of bias' domains. The two trials in women with previous caesarean sections were performed at the same institution a few years apart. We have found that overall, the findings are at a moderate to high risk of bias. Please see Figure 2 for a summary of the risk of bias.
We used GRADEpro software to grade evidence for our selected outcomes; for caesarean section we rated the evidence low quality and all the other outcomes, perinatal mortality, wound sepsis, blood transfusion, scar dehiscence and admission to special care baby unit as very low quality. Downgrading was due to risk of bias relating to lack of allocation concealment and blinding, and imprecision of effect estimates. Please see Table 1 .
We took steps to reduce bias as we are aware of the potential to introduce bias throughout the process of writing the review. Two review authors assessed each study for possible inclusion, assessed the quality of the trials and extracted data independently. We recognise that assessing the quality of the trials can be subjective and that different people assessing risk of bias may have come up with different judgements.
The results of this review agree with another non‐Cochrane systematic review that looked at clinical interventions, including X‐ray pelvimetry, which increased vaginal birth after caesarean section (VBAC) ( Catling‐Paull 2011 ). Catling‐Paull 2011 found that X‐ray pelvimetry was a poor predictor of birth outcome, and that women who received pelvimetry were less likely to attempt a vaginal birth. Subsequently, the caesarean section rate was higher in the groups where women had pelvimetry.
X‐ray pelvimetry versus no pelvimetry or clinical pelvimetry is the only comparison included in this review due to the lack of trials identified that used other types or pelvimetry (e.g. other radiological examinations). There is not enough evidence to support the use of X‐ray pelvimetry for deciding on the mode of delivery in women whose fetuses have a cephalic presentation, and the practice may be harmful to the mother by increasing the risk of having a caesarean section, without increasing the benefit to the fetus or neonate.
Further research should be directed towards defining whether there are specific clinical situations, for example, breech presentations, in which X‐ray pelvimetry can be shown to be of value. Newer methods of pelvimetry should be subjected to randomised trials to assess their value.
Further trials of X‐ray pelvimetry in cephalic presentations would be of value if large enough to assess the effect on perinatal mortality.
It occurred to me that, having been involved with dogs with large heads and tiny pelvices that a simple measurement of the widest part of the pelvis may be related to the chances of dystocia. A basic measurement at any stage of pregnancy. or before. may predict with some, not all, as exceptions in nature are the rule, accuracy the chances of dystocia. these women could therefore be identified and prepared [in all sorts of ways] for the likelihood of dystocia.
17 December 2020 | Feedback has been incorporated | Added from Anthony Todd |
17 December 2020 | Amended | Feedback added to review pending response from the review authors. |
Protocol first published: Issue 2, 1997 Review first published: Issue 2, 1997
31 January 2017 | New search has been performed | Search updated and one trial added. |
31 January 2017 | New citation required but conclusions have not changed | For this update, we assessed two reports of one trial from a search of Cochrane Pregnancy and Childbirth's Trials Register (January 2017). In total, five trials are now included ( ; ; ; ; ) and one is excluded ( ). GRADEpro Guideline Development Tool was used to import data from Review Manager 5.3 ( ) in order to create a 'Summary of findings’ table. |
17 August 2010 | New search has been performed | Search updated. No new trial reports identified. |
20 September 2008 | Amended | Converted to new review format. |
27 June 2007 | New search has been performed | Search updated. No new trials identified. |
1 June 2004 | New search has been performed | E Farrrell joined the review team. The title has been changed to include "or near term". A new literature search revealed no new studies relating to this review. Major changes have been made to the background, small changes to the criteria and some comments on the methodological quality of the articles. This was to comply with the reviewers' comments made previously. The ongoing study on clinical pelvimetry that was included previously has not been published. The randomisation for the trial did not work, as there were too few patients who were regarded as having small pelvises and all the revealed group's patients ignored the clinicians' advice. |
1 April 2002 | Amended | A new literature search revealed no new studies relating to this review. There are very minor changes to the review, namely stipulating that X‐ray pelvimetry was used in all the trials. In the next update a comment will be made on clinical pelvimetry. An ongoing study on clinical pelvimetry has been included in the ongoing studies section. The trial has been completed and as soon as it is published will be included in the review. |
Professor Justus Hofmeyr and Ms Cheryl Nikodem for assisting me with the study and teaching me (V Vannevel) the use of Review Manager. Thanks to Therese Dowswell (Cochrane Pregnancy and Childbirth) for her contribution in assessing studies and help preparing the 'Summary of findings' table for this update (2016).
This research was supported by a grant from the Department of Reproductive Health and Research, World Health Organization (WHO). The findings, interpretations and conclusions expressed in this paper are entirely those of the authors and should not be attributed in any manner whatsoever to WHO.
We thank El‐Marie Farrell for contributions to the previous update.
As part of the pre‐publication editorial process, this review has been commented on by three peers (an editor and two referees who are external to the editorial team), a member of Cochrane Pregnancy and Childbirth's international panel of consumers and the Group's Statistical Adviser.
This project was supported by the National Institute for Health Research, via Cochrane Infrastructure funding to Cochrane Pregnancy and Childbirth. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health.
Edited (no change to conclusions)
Comparison 1.
Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
---|---|---|---|---|
5 | 1159 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.34 [1.19, 1.52] | |
1.1.1 No previous caesarean section | 3 | 769 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.24 [1.02, 1.52] |
1.1.2 Previous caesarean section | 2 | 390 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.45 [1.26, 1.67] |
5 | 1159 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.53 [0.19, 1.45] | |
1.2.1 No previous caesarean section | 3 | 769 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.64 [0.21, 1.90] |
1.2.2 Previous caesarean section | 2 | 390 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.19 [0.01, 3.91] |
1 | 288 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.80 [0.22, 2.92] | |
1.3.1 No previous caesarean section | 0 | 0 | Risk Ratio (M‐H, Fixed, 95% CI) | Not estimable |
1.3.2 Previous caesarean section | 1 | 288 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.80 [0.22, 2.92] |
1 | 288 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.83 [0.26, 2.67] | |
1.4.1 No previous caesarean section | 0 | 0 | Risk Ratio (M‐H, Fixed, 95% CI) | Not estimable |
1.4.2 Previous caesarean section | 1 | 288 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.83 [0.26, 2.67] |
1 | 288 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.00 [0.39, 2.59] | |
1.5.1 No previous caesarean section | 0 | 0 | Risk Ratio (M‐H, Fixed, 95% CI) | Not estimable |
1.5.2 Previous caesarean section | 1 | 288 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.00 [0.39, 2.59] |
2 | 390 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.59 [0.14, 2.46] | |
1 | 305 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.66 [0.39, 1.10] | |
1 | 288 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.20 [0.01, 4.13] | |
1.8.1 No previous caesarean section | 0 | 0 | Risk Ratio (M‐H, Fixed, 95% CI) | Not estimable |
1.8.2 Previous caesarean section | 1 | 288 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.20 [0.01, 4.13] |
Characteristics of included studies [ordered by study id].
Methods | Prospective randomised controlled trial in a hospital setting. 2 treatment arms. | |
Participants | 305 labouring women randomised whose attending doctors requested pelvimetry by radiography. | |
Interventions | 151 women allocated to intrapartum x‐ray pelvimetry when requested by staff. 154 women allocated to no pelvimetry when requested by staff. | |
Outcomes | ||
Notes | No electronic fetal heart rate monitoring used. No information on the indication for X‐ray pelvimetry except that the doctor wished to have it performed on a woman in labour. No blinding of staff, this could possibly affect results if staff requesting pelvimetry are not able to use it. Hospital setting in country not explicitly named but likely to be South Africa. Funding source: not stated. Dates study was conducted: unclear Declarations of interest of primary researchers: unclear | |
Random sequence generation (selection bias) | Unclear risk | "Intrapartum radiography‐when desired by staff‐would only be permitted if an envelope removed front the box contained permission typed "yes" as opposed to the refusal typed "no". Obviously no exceptions were permitted this rule." |
Allocation concealment (selection bias) | Unclear risk | No mention in text. |
Blinding of participants and personnel (performance bias) All outcomes | High risk | Called "double‐blind" but no further details are given. Staff would have been aware of whether or not pelvimetry was permitted, women may not have been told. Clinical management may have been affected by knowledge of allocation. |
Blinding of outcome assessment (detection bias) All outcomes | High risk | Assessment of some of the outcomes (e.g. neonatal well‐being) may have been affected by lack of blinding. Assessment may have been by staff aware of allocation. |
Incomplete outcome data (attrition bias) All outcomes | Low risk | Appears complete. |
Selective reporting (reporting bias) | Unclear risk | Protocol not available, outcomes not pre‐specified in methods. |
Other bias | Unclear risk | No other bias apparent but baseline characteristics of participants not reported. |
Methods | Prospective 2‐armed randomised controlled trial. | |
Participants | 264 women randomised. Pregnant nulliparous women Aged between 20‐35 ≥ 37 weeks' gestation Normal placental function With a medical indication for induction of labour Multiple birth pregnancies Breech position | |
Interventions | 133 women, X‐ray pelvimetry before their induction according to the Bedoya technique. 131 women, not given X‐ray pelvimetry before their induction. | |
Outcomes | 1. Time taken from induction to expulsion or extraction of the fetus 2. Method of extraction (labour or caesarean) 3. Use of instruments during the birth (forceps etc.) 4. Any secondary/adverse effects 5. Perinatal mortality | |
Notes | Conducted at the unit of clinical management, University Hospital Virgen Macarena in Seville, Spain. Funding source: not stated. Dates study was conducted: unclear Declarations of interest of primary researchers: unclear | |
Random sequence generation (selection bias) | Low risk | 264 women were chosen in strict chronological order and were distributed into 2 groups according to a random number table. |
Allocation concealment (selection bias) | Unclear risk | The random number table was only known by the head researcher in charge of recruitment, the doctor responsible for inductions and the only person who was authorised to take clinical decisions in relation to the use of the X‐ray pelvimetry, which was always evaluated before proceeding with the induction of labour. |
Blinding of participants and personnel (performance bias) All outcomes | High risk | "All women who underwent X‐PM were informed of the process in detail and were only included in the study if they gave their consent." Following the induction, the medical staff working during the labour (obstetric surgeons and midwives) were not aware if the woman had undergone X‐ray pelvimetry. Although there was an attempt to blind some staff, women were aware of the pelvimetry. It is likely this blinding could have been broken. |
Blinding of outcome assessment (detection bias) All outcomes | High risk | As blinding of staff is not convincing, some outcomes may have been affected by the lack of blinding. |
Incomplete outcome data (attrition bias) All outcomes | Low risk | Appears complete. |
Selective reporting (reporting bias) | Unclear risk | Not all outcomes are mentioned‐ unclear if this is due to translation. |
Other bias | Unclear risk | In text of study it says that 21 caesarean sections were done in each group but the table data shows different, higher numbers. |
Methods | Prospective randomised study at the University of Illinois Hospital, Chicago. Women individually randomised by hospital number. 2 treatment arms. | |
Participants | 200 women randomised when admitted to hospital for induction or augmentation of labour using oxytocin. primigravida with vertex presentation. | |
Interventions | : 102 women allocated to receive clinical and X‐ray pelvimetry before induction or augmentation. : 98 women allocated to receive no X‐ray pelvimetry before induction or augmentation. This group all received clinical pelvimetry. | |
Outcomes | ||
Notes | All women monitored with electronic fetal heart rate monitoring and intrauterine pressure monitors. Funding source: not stated. Dates study was conducted: unclear Declarations of interest of primary researchers: unclear | |
Random sequence generation (selection bias) | High risk | "Patients were randomised into two groups by hospital number." |
Allocation concealment (selection bias) | High risk | Randomisation by hospital number means that staff recruiting women to the study may have been able to anticipate randomisation group. |
Blinding of participants and personnel (performance bias) All outcomes | High risk | Blinding of patients is not likely with this intervention. "The management of all patients then proceeded on the basis of clinical and/or x‐ray evaluation, and the investigators did not participate in the evaluation of the pelvises in the management plan." Does not appear staff were blinded which could have affected treatment of both intervention and comparison groups. |
Blinding of outcome assessment (detection bias) All outcomes | High risk | The recording of outcomes was by a member of staff caring for the patient who would be aware of randomisation group. It was stated that the investigators did not participate in the evaluation of pelvises but all other clinical staff would be aware of the intervention. |
Incomplete outcome data (attrition bias) All outcomes | Low risk | Appears complete, reports outcomes for all participants. |
Selective reporting (reporting bias) | Unclear risk | No protocol but outcomes stated in methods section. Length of labour data reported narratively, no actual data. |
Other bias | Low risk | No baseline imbalance reported. No other bias apparent. |
Methods | Prospective randomised controlled trial. Women individually randomised. 2 treatment arms. | |
Participants | 102 women randomised. pregnant women with 1 previous caesarean section. previous caesarean section used a classical uterine incision | |
Interventions | 52 women allocated to receive X‐ray pelvimetry at 36 weeks' gestation. If the pelvic inlet was < 10.5 cm in the antero‐posterior diameter or < 11. 5 cm in the transverse diameter, an elective caesarean section was performed. A trial of scar was performed on the rest. 50 women allocated to no antenatal pelvimetry and all women had a trial of scar. Spontaneous labour was awaited. X‐ray pelvimetry was performed postpartum. | |
Outcomes | 1. Mode of delivery 2. Pelvimetry measurements 3. Birthweight 4. Average stay in hospital | |
Notes | 2 stillbirths occurred in the control prior to the onset of labour, both were thought to be due to post maturity. Both scar dehiscences were diagnosed by bimanual examination following normal vaginal deliveries, and repaired by laparotomy without any further complication. Trial took place at King Edward VIII Hospital, Durban. Funding source: not stated. Dates study was conducted: unclear Declarations of interest of primary researchers: unclear | |
Random sequence generation (selection bias) | Unclear risk | "Randomly allocated to two groups." No further information given. |
Allocation concealment (selection bias) | Unclear risk | Not mentioned. |
Blinding of participants and personnel (performance bias) All outcomes | High risk | No blinding. Knowledge of treatment group may have affected clinical treatment. |
Blinding of outcome assessment (detection bias) All outcomes | High risk | Some of the outcomes may have been affected by lack of blinding. |
Incomplete outcome data (attrition bias) All outcomes | Unclear risk | Denominators not given in results tables. |
Selective reporting (reporting bias) | Unclear risk | Outcomes not prespecified in text. |
Other bias | Unclear risk | No other bias apparent. |
Methods | Prospective randomised controlled trial. Women individually randomised. 2 treatment arms. | |
Participants | 288 women randomised. : women with 1 previous transverse lower segment caesarean section. ‐ abnormal lie or presentation; ‐ obstetric complications requiring planned delivery; ‐ maternal disorders contra‐indicating a trial of scar; ‐ multiple pregnancy; ‐ preterm labour; ‐ grossly contracted pelvis on clinical examination; ‐ intrauterine death. | |
Interventions | : 144 women allocated to x‐ray pelvimetry group at 36 weeks. A sagittal inlet < 11 cm, sagittal outlet < 10 cm, transverse inlet < 11.5 cm, and transverse outlet (bispinous) < 9 cm was an indication for caesarean section. The remainder of the group awaited spontaneous labour and underwent a 'trial of scar’. 144 women had no pelvimetry at 36 weeks and awaited spontaneous labour. | |
Outcomes | ||
Notes | 153 women were randomised to either group. In the study group, 1 withdrew consent, 2 had breech presentations, 2 had twin pregnancies, 2 had hypertension and 2 developed preterm labour. In the control group 3 elected to have an elective caesarean section, 2 had breech presentations, 1 twin gestation, 2 hypertensives and 1 preterm labour. Each group consisted finally of 144 women. Analysis was on the last number and not according to intention to treat. 6 women had scar dehiscences, 2 diagnosed in labour (control group) and 4 on routine digital examination after delivery. None of the women required hysterectomy or had postpartum haemorrhage. Trial took place at King Edward VIII Hospital, Durban. Funding source: not stated. Dates study was conducted: randomisation occurred "during the second half of 1990", primary outcome follow‐up completed February 1991 Declarations of interest of primary researchers: unclear | |
Random sequence generation (selection bias) | High risk | "Randomisation and equal distribution were assured because women were allocated alternately to the two teams by admitting clerks who had no medical training and no knowledge of how they would be managed." |
Allocation concealment (selection bias) | High risk | Not mentioned but a different medical team provided the intervention and control care therefore no concealment attempted. |
Blinding of participants and personnel (performance bias) All outcomes | High risk | Not mentioned. Difficult to blind this type of intervention. |
Blinding of outcome assessment (detection bias) All outcomes | High risk | Management of care and outcome recording was done by different teams of staff for women in the 2 groups. This means outcomes may not have been measured and recorded in the same way. |
Incomplete outcome data (attrition bias) All outcomes | Unclear risk | 306 women randomised. 288 followed up ‐ loss was relatively low but loss of 2 women in the pelvimetry group related to outcomes (women opted for caesarean section). |
Selective reporting (reporting bias) | Unclear risk | Outcomes not mentioned in methods text, protocol not available. |
Other bias | Low risk | Baseline characteristics appeared similar. Other bias not apparent. |
Study | Reason for exclusion |
---|---|
Trial was stopped prior to completion as randomisation not adequate. There were too few women recruited and study protocol was not adhered to. |
Title: We changed the title from Pelvimetry for fetal cephalic presentations at or near term to Pelvimetry for fetal cephalic presentations at or near term for deciding on mode of delivery .
Objectives: We removed assessing the effects of postnatal pelvimetry from the objectives as this could not impact on mode of delivery.
We also removed the following hypothesis.
We have clarified aspects in the section on Criteria for considering studies for this review, as follows:
All acceptably randomised comparisons of the use of pelvimetry in cephalic presentations in:
has changed to:
Pregnant women with singleton, cephalic presentation fetus who have or have not had a previous caesarean section. Studies which recruited women before, or during labour were included as well as women for spontaneous labour, induction or trial of scar after previous caesarean section.
Policy of elective caesarean section or trial of labour or scar depending on the prediction of pelvimetry as opposed to trial of labour or scar in all.
Outcomes: We changed ' Caesarean section/symphysiotomy' to ' Caesarean section'. Crichton 1962 only, reported the composite outcome of caesarean section/symphysiotomy, and did not report data for these outcomes separately. It is not clear how many symphysiotomies were performed in this trial and we could not report the data as two separate outcomes. We have documented this in the results section and in footnotes in Analysis 1.1 .
'Summary of findings' table: We assessed the trial quality by using GRADE assessment. This is documented in Table 1 .
V Vannevel assisted RC Pattinson with the 2016 update. V Vannevel analysed and interpreted the results, and prepared the update. A Cuthbert assessed studies for inclusion and prepared the 'Summary of findings' table.
Internal sources.
Robert C Pattinson: no conflict of interest. Anna Cuthbert: no conflict of interest. Valerie Vannevel: no conflict of interest.
Crichton 1962 {published data only}.
Farrell 2002 {unpublished data only}.
Catling‐paull 2011.
Pattinson 1997.
IMAGES
VIDEO
COMMENTS
If you hear your doctor mention cephalic presentation, you might wonder what it means and whether it's a good thing. Learn more about birth positions, how to move your baby, and cephalic presentation.
The cephalic position (head down) is the safest position for a fetus during labor and delivery. Learn why and the risks of other positions.
Fetal presentation before birth The way a baby is positioned in the uterus just before birth can have a big effect on labor and delivery. This positioning is called fetal presentation. Babies twist, stretch and tumble quite a bit during pregnancy.
Occiput anterior is a type of head-first or cephalic presentation for delivery of a baby. About 95 to 97 percent of babies position themselves in a cephalic presentation for delivery, often with the crown or top of their head - which is also known as the vertex - entering the birth canal first.
Delivery presentation describes the way the baby is positioned to come down the birth canal for delivery. The best position for your baby inside your uterus at the time of delivery is head down. This is called cephalic presentation. This position makes it easier and safer for your baby to pass through the birth canal.
Position and Presentation of the Fetus Toward the end of pregnancy, the fetus moves into position for delivery. Normally, the presentation is vertex (head first), and the position is occiput anterior (facing toward the pregnant person's spine) and with the face and body angled to one side and the neck flexed.
After birth, mother and infant are in good condition" [ 1 ]. This topic will present a paradigm for intrapartum management of the first stage of labor (ie, onset to full cervical dilation) in pregnant people who are expected to have a normal singleton vaginal cephalic birth.
Fetal Presentation The presenting part is the portion of the fetal body either within or in closest proximity to the birth canal. It usually can be felt through the cervix on vaginal examination. In longitudinal lies, the presenting part is either the fetal head or the breech, creating cephalic and breech presentations, respectively. When the fetus lies with the long axis transversely, the ...
In the cephalic presentation, the baby is head down, chin tucked to chest, facing their mother's back. This position typically allows for the smoothest delivery, as baby's head can easily move down the birth canal and under the pubic bone during childbirth.
This comprehensive guide explores the meaning, types, benefits and likelihood of normal delivery associated with cephalic presentation.
Cephalic presentation Almost all (95-97%) babies are delivered by cephalic presentation, where they are head-down with legs and feet at the top of the uterus. Most babies move into the head-down position by the third trimester. Cephalic presentation is further broken down by the position of the head; in the vast majority of cephalic deliveries, the crown or top of the head (called the vertex ...
What are the different types of presentation my baby could be in during pregnancy and birth? Most babies present headfirst, also known as cephalic presentation. Most babies that are headfirst will be vertex presentation. This means that the crown of their head sits at the opening of your birth canal.
The term presentation describes the leading part of the fetus or the anatomical structure closest to the maternal pelvic inlet during labor. The presentation can roughly be divided into the following classifications: cephalic, breech, shoulder, and compound. Cephalic presentation is the most common and can be further subclassified as vertex, sinciput, brow, face, and chin. The most common ...
To understand and recognize a normal labor pattern. To understand the mechanism of labor for a cephalic presentation. To understand the meaning of the following germs: Presentation, position, lie, station, effacement, dilatation. To understand the phases and stages of labor. To understand the following abnormalities of labor: Prolonged latent ...
This position makes it easier and safer for your baby to pass through the birth canal. Cephalic presentation occurs in about 97% of deliveries. There are different types of cephalic presentation, which depend on the position of the baby's limbs and head (fetal attitude).
Cephalic presentation. In obstetrics, a cephalic presentation or head presentation or head-first presentation is a situation at childbirth where the fetus is in a longitudinal lie and the head enters the pelvis first; the most common form of cephalic presentation is the vertex presentation, where the occiput is the leading part (the part that ...
For breech presentation, usually do cesarean delivery at 39 weeks or during labor, but external cephalic version is sometimes successful before labor, usually at 37 or 38 weeks.
Presentation during labour refers to which part of the baby enters the birth canal first. Normally, the crown of the head will enter first, which is known as cephalic presentation. Other forms of presentation such as breech presentation may cause difficulties with birth.
Plain language summary Pelvimetry for fetal cephalic presentations at or near term for deciding on mode of delivery What is the issue? Does the use of pelvimetry to assess the size of the woman's pelvis improve outcomes for baby and mother? Pelvimetry might identify babies whose heads are too big for their mother's pelvis.
Depending on your condition, the doctor may recommend External Cephalic Version, wherein they'll try to turn the baby to a cephalic presentation by applying calculated pressure to the abdomen. After all, if the baby is in breech position, the possibility of having a Cesarean delivery increases. At home, you may also find yourself browsing ...
BACKGROUND: The increase in the use of induction of labor is a worldwide phenomenon in the current management of labor and delivery in Western societies, with approximately one out of every four pregnancies undergoing this procedure This has led women to seek various methods for stimulation of the onset of labor. Some data suggest that the use of acupuncture for favoring spontaneous labor ...