Pelvimetry for fetal cephalic presentations at or near term for deciding on mode of delivery

Robert C Pattinson; Anna Cuthbert; Valerie Vannevel

doi:10.1002/14651858.CD000161.pub2

Scolaris Content Display Scolaris Content Display

Contenido relacionado

Ir a:

Revisiones y protocolos relacionados
Guías
Temas

Revisiones y protocolos relacionados

Topics

Temas

Figure 1

Study flow diagram.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 2

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 3

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.1

Comparison 1: X‐ray pelvimetry versus no X‐ray pelvimetry, Outcome 1: Caesarean section

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.2

Comparison 1: X‐ray pelvimetry versus no X‐ray pelvimetry, Outcome 2: Perinatal mortality

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.3

Comparison 1: X‐ray pelvimetry versus no X‐ray pelvimetry, Outcome 3: Puerperal pyrexia

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.4

Comparison 1: X‐ray pelvimetry versus no X‐ray pelvimetry, Outcome 4: Wound sepsis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.5

Comparison 1: X‐ray pelvimetry versus no X‐ray pelvimetry, Outcome 5: Blood transfusion

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.6

Comparison 1: X‐ray pelvimetry versus no X‐ray pelvimetry, Outcome 6: Scar dehiscence

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.7

Comparison 1: X‐ray pelvimetry versus no X‐ray pelvimetry, Outcome 7: Perinatal asphyxia

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.8

Comparison 1: X‐ray pelvimetry versus no X‐ray pelvimetry, Outcome 8: Admission to special care baby units

Ir a la figura de la revisiónAbrir en una pestaña nueva

Summary of findings 1. X‐ray pelvimetry compared to no X‐ray pelvimetry in cephalic presentations for fetal cephalic presentations at or near term

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Quality of the evidence (GRADE)	Comments
X‐ray pelvimetry compared to no X‐ray pelvimetry in fetal cephalic presentations at or near term
Patient or population: pregnant women at or near term with fetal cephalic presentations Setting: hospital settings in Spain, United States, and South Africa. Intervention: X‐ray pelvimetry Comparison: no X‐ray pelvimetry in cephalic presentations
Outcomes	Risk with no pelvimetry in cephalic presentations	Risk with X‐ray pelvimetry	Relative effect (95% CI)	№ of participants (studies)	Quality of the evidence (GRADE)	Comments
Caesarean section	Study population		RR 1.34 (1.19 to 1.52)	1159 (5 RCTs)	⊕⊕⊝⊝ LOW ¹	One study Crichton 1962 reported caesarean section and symphysiotomy together
Caesarean section	388 per 1000	520 per 1000 (462 to 590)	RR 1.34 (1.19 to 1.52)	1159 (5 RCTs)	⊕⊕⊝⊝ LOW ¹
Perinatal mortality	Study population		RR 0.53 (0.19 to 1.45)	1159 (5 RCTs)	⊕⊝⊝⊝ VERY LOW ^{2 3}
Perinatal mortality	17 per 1000	9 per 1000 (3 to 25)	RR 0.53 (0.19 to 1.45)	1159 (5 RCTs)	⊕⊝⊝⊝ VERY LOW ^{2 3}
Wound sepsis	Study population		RR 0.83 (0.26 to 2.67)	288 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{4 5}
Wound sepsis	42 per 1000	35 per 1000 (11 to 111)	RR 0.83 (0.26 to 2.67)	288 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{4 5}
Blood transfusion	Study population		RR 1.00 (0.39 to 2.59)	288 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{3 4}
Blood transfusion	56 per 1000	56 per 1000 (22 to 144)	RR 1.00 (0.39 to 2.59)	288 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{3 4}
Scar dehiscence	Study population		RR 0.59 (0.14 to 2.46)	390 (2 RCTs)	⊕⊝⊝⊝ VERY LOW ^{5 6}
Scar dehiscence	26 per 1000	15 per 1000 (4 to 63)	RR 0.59 (0.14 to 2.46)	390 (2 RCTs)	⊕⊝⊝⊝ VERY LOW ^{5 6}
Admission to special care baby units	Study population		RR 0.20 (0.01 to 4.13)	288 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{4 5}
Admission to special care baby units	14 per 1000	3 per 1000 (0 to 57)	RR 0.20 (0.01 to 4.13)	288 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{4 5}
Apgar score < 7 at 5 minutes	Study population		‐	(0 studies)	‐	No data reported for this outcome
Apgar score < 7 at 5 minutes	see comment	see comment	‐	(0 studies)	‐	No data reported for this outcome
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
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)

Summary of findings 1. X‐ray pelvimetry compared to no X‐ray pelvimetry in cephalic presentations for fetal cephalic presentations at or near term

Ir a la tabla de la revisión

Comparison 1. X‐ray pelvimetry versus no X‐ray pelvimetry

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1.1 Caesarean section Show forest plot	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]
1.2 Perinatal mortality Show forest plot	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]
1.3 Puerperal pyrexia Show forest plot	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]
1.4 Wound sepsis Show forest plot	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]
1.5 Blood transfusion Show forest plot	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]
1.6 Scar dehiscence Show forest plot	2	390	Risk Ratio (M‐H, Fixed, 95% CI)	0.59 [0.14, 2.46]

1.7 Perinatal asphyxia Show forest plot	1	305	Risk Ratio (M‐H, Fixed, 95% CI)	0.66 [0.39, 1.10]

1.8 Admission to special care baby units Show forest plot	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]

Comparison 1. X‐ray pelvimetry versus no X‐ray pelvimetry

Ir a la tabla de la revisión

The Cochrane Library

Scolaris Language Selector Scolaris Language Selector

Idioma de la Revisión Cochrane

Idioma de la web

Scolaris Content Language Banner Portlet Scolaris Content Language Banner Portlet