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.
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Constantine, Sarah MBBS, FRANZCR ∗ ; Kiermeier, Andreas PhD (Stat) † ; Anderson, Peter DSc, DDSc, MD (Edin), PhD, MSurg (Melb), MFST (Ed), FDSRCS (Ed), FDSRCS (Eng), FRCS (Eng), FRCS (Plast.), FACS, FRACS ‡
∗ Department of Medical Imaging, Women's and Children's Hospital
† Statistical Process Improvement Consulting and Training Pty Ltd
‡ Australian Craniofacial Unit, Women's and Children's Hospital, North Adelaide, SA, Australia.
Received for publication December 27, 2018; accepted February 20, 2019.
The authors declare no conflicts of interest.
Address correspondence to: Sarah Constantine, MBBS, FRANZCR, Department of Medical Imaging, Women's and Children's Hospital, Level 2, 72 King William Rd, North Adelaide, SA 5006, Australia (e-mail: [email protected] ).
Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site ( www.ultrasound-quarterly.com ).
The cephalic index (CI) is used in the evaluation of individuals with craniosynostosis. There is little agreement as to the normal range and stability of the CI during the fetal period, partly due to limited literature. We sought to determine the range, distribution and stability of the fetal CI in the second half of pregnancy. We also aimed to identify any relationship to delivery complications such as obstructed labor and malpresentation.
The fetal head circumference, biparietal diameter (BPD) and occipitofrontal diameter (OFD) measurements were obtained from standard ultrasound images. Each of 4304 fetuses had measurements taken at morphology scan performed between 17 and 22 weeks' gestation, and at growth scanning at 28 to 33 weeks' gestation. The cephalic index was calculated using the formula: CI = BPD/OFD × 100. The distribution of the CI at both scans is very close to a normal distribution. The mean CI at 17 to 22 weeks was 75.9 (SD, 3.7); the mean CI at 28 to 33 weeks was 77.8 (SD, 3.5). The mean change in CI was 1.9 (SD, 4.28), which is not statistically significantly different from zero ( t = 0.656, P = 0.512, 95% confidence interval). No relationship was found between the CI in normal fetuses and delivery complications. There is a wide variation in the change in CI in the third trimester. A value below the normal range in the third trimester or a progressive reduction in CI during the latter half of pregnancy should provoke detailed scanning of the fetal cranial sutures to check for craniosynostosis.
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Evaluation of soft-tissue hematomas with real-time, contrast-enhanced..., sonographic diagnosis of velamentous and marginal placental cord insertion.
Between the 29th and 32nd week of pregnancy, the baby continues to be very active and makes numerous movements.
Each pregnancy is different and there is no particular amount of movements a mother should be expecting to feel at this stage, but she should be aware of the baby’s movement pattern and contact her local hospital or midwife if this pattern starts to change.
During this period of growth, the baby’s sucking reflex is developing where it can now suck its thumb and fingers.
The baby is also gaining weight and starting to look less wrinkled, as fat stores smooth out the skin.
The greasy vernix and fine hair (lanugo) that cover and protect the baby’s delicate skin has begun to disappear and the baby’s eyes can now focus.
Lung development is rapid, although the baby still wouldn’t be able to breathe independently at this stage.
By the 32nd week, the baby may be positioned with its head pointing downwards, in preparation for birth. This positioning is referred to as cephalic presentation.
If the baby is not lying in this position at this stage, there is no cause for concern as there is still enough time for the baby to turn.
Billions of neurons are developing in the brain and the lungs and muscles are still maturing.
The head is growing larger to accommodate the growing brain and the eyes can move and possibly even follow a light outside of the abdomen.
The baby is still positioned with the head up at this stage, but will move into the birthing position in the coming weeks.
The baby is quite active, although there may be less movement than previously due to the uterus becoming more cramped.
The reduced space in the abdomen may mean the mother frequently experiences problems such as trapped wind or heartburn.
The baby’s eyes are now often wide open and the baby may have a substantial amount of hair.
Red blood cells are now developing in the bone marrow and there is also a great deal of brain development at this stage. The baby now measures about 270 mm and weighs around 1,300 grams (3 pounds).
The mother may have felt the beginning of “practice” contractions, referred to as Braxton Hicks. These contractions can feel intense sometimes, but they are not painful.
At 31 weeks, the central nervous system has developed to the point that it can control body temperature. Space in the uterus is limited and the mother can expect to feel fewer movements.
The major organs are now almost fully mature and growth now becomes more focused on maturing those organs and growing stores of fat and muscle.
The mother can expect the baby’s weight to double between this stage and birth. The eyes are now fully open and the irises can contract and dilate in response to light.
The mother can also expect to experience indigestion, sleeplessness, backache and weight gain. It is normal for the mother to be gaining around one pound each week at this stage.
Although the lungs are still not fully matured, the baby is practising breathing. The body also starts to absorb minerals from the intestinal tract such as iron and calcium. The lanugo that protected the baby’s delicate skin begins to fall off.
A baby born at this stage has a good chance of survival, although the baby would still be in need of intensive medical care to aid breathing and feeding.
The baby now measures around 280mm and weighs about 3.75 pounds or 1,700 grams.
Last Updated: Feb 27, 2019
Sally first developed an interest in medical communications when she took on the role of Journal Development Editor for BioMed Central (BMC), after having graduated with a degree in biomedical science from Greenwich University.
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Share this page, i am a 29 year old pregnant woman waiting to deliver my kid next week due to some complications in my pregnancy. i would like to know how my baby’s cephalic presentation would be at 33 weeks because head first is the way to deliver a baby naturally. can someone answer this question for me.
Asked for Female, 29 Years 20230 Views v
cephalic presentation is the presentation in which the head present first ..If you're trying for normal vaginal delivery then this is the favourable position... however if you are delivering earlier ... Read More
Asked for Female, 28 Years 21427 Views v
There is literally nothing which you can do about the baby's position because the baby keeps on moving in the womb.. cephalic position as such means a normal position for a vaginal delivery but whethe ... Read More
Talk to experienced gynaecologist online and get your health questions answered in just 5 minutes.
Asked for Female, 29 Years 1322 Views v
Position is fixed after 36 weeks Yes cephalic position is favorable fr delivery ... Read More
Asked for Female, 29 Years 2363 Views v
Normal Yes may change Position fixes at 36 weeks ... Read More
Asked for Female, 29 Years 5152 Views v
Cephalic presentation is gud sign.... If the head is fixed n BPD is within 9.2cms then gud chances of normal delivery ... Read More
Asked for Female, 37 Years 6013 Views v
cephalic position is presentation by vertex..which s the favourable position for normal vaginal delivery... and the total pregnancy s 40 weeks but baby becomes mature after 37 weeks for u to deliver ... Read More
Asked for Female, 26 Years 10000 Views v
Need details about your concern Connect with me online for detailed consultation Https://prac.to/drdigvijay ... Read More
Asked for Female, 35 Years 9182 Views v
Cephalic means baby is with head down position which is normal position. ... Read More
Asked for Female, 31 Years 1967 Views v
Hi dear it's normal You can easily take an online consultation for further treatment guidance Homeopathic medicines are well proved to promote a healthy pregnancy and normal delivery Visit my webs ... Read More
Asked for Female, 28 Years 2291 Views v
Cephalic ppt mean the head of the baby is down at the right position for normal delivery But wether normal delivery is possible or not can’t say as that depends on various other factors like weight o ... Read More
Asked for Female, 25 Years 739 Views v
Pls connect for online consultation and advice ... Read More
Asked for Female, 31 Years 62 Views v
Nothing to be done, plenty of fluids And general hygiene ... Read More
Asked for Female, 27 Years 107 Views v
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Asked for Female, 29 Years 967 Views v
Yes it is Walk 45 min daily ... Read More
Asked for Female, 30 Years 532 Views v
Yes there are chances ... Read More
Asked for Female, 31 Years 772 Views v
That's normal Kicks will be felt where the feet n hands are ... Read More
Asked for Female, 35 Years 592 Views v
Incomplete information Need the ultrasound to comment Was the dual test normal? ... Read More
Asked for Female, 29 Years 190 Views v
Please consult for proper discussion. ... Read More
Asked for Female, 26 Years 1431 Views v
Consult obstetrician ... Read More
Asked for Female, 31 Years 148 Views v
BP , sugar, hemoglobin to be checked Take plenty of fluids Take rest Take small frequent meals Consult ur doctor ... Read More
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Consult gynaecologist asap ... Read More
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History noted. More details needed for proper evaluation. You can consult on Practo app or on 8318"469886. ... Read More
Asked for Female, 27 Years 117 Views v
Contact me on practo for detailed information about this and treatment for the same. ... Read More
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Please observe over the next few days. ... Read More
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Hi there, that's absolutely fine. Nothing to worry about. Those are the changes common in pregnancy. Make sure you feel baby movements. ... Read More
Asked for Female, 28 Years 378 Views v
Yes Movements will regularise in coming few weeks. Best time to feel movements is after full food lying on one side and concentrating on movements for an hour. Take your iron and calcium tablets prope ... Read More
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Fear during 24 weeks, iugr diagnosed in 24 weeks, pregnancy week 24 weeks 6 days, lost my baby @ 24 weeks, baby movements 24 weeks.
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La nina and warmer-than-average ocean temperatures are major drivers of tropical activity.
NOAA's GOES-16 satellite captured Hurricane Idalia approaching the western coast of Florida while Hurricane Franklin churned in the Atlantic Ocean at 5:01 p.m. EDT on August 29, 2023.
NOAA National Weather Service forecasters at the Climate Prediction Center predict above-normal hurricane activity in the Atlantic basin this year. NOAA’s outlook for the 2024 Atlantic hurricane season, which spans from June 1 to November 30, predicts an 85% chance of an above-normal season, a 10% chance of a near-normal season and a 5% chance of a below-normal season.
NOAA is forecasting a range of 17 to 25 total named storms (winds of 39 mph or higher). Of those, 8 to 13 are forecast to become hurricanes (winds of 74 mph or higher), including 4 to 7 major hurricanes (category 3, 4 or 5; with winds of 111 mph or higher). Forecasters have a 70% confidence in these ranges. The upcoming Atlantic hurricane season is expected to have above-normal activity due to a confluence of factors, including near-record warm ocean temperatures in the Atlantic Ocean, development of La Nina conditions in the Pacific, reduced Atlantic trade winds and less wind shear, all of which tend to favor tropical storm formation.
“With another active hurricane season approaching, NOAA’s commitment to keeping every American informed with life-saving information is unwavering,” said NOAA Administrator Rick Spinrad, Ph.D. “AI-enabled language translations and a new depiction of inland wind threats in the forecast cone are just two examples of the proactive steps our agency is taking to meet our mission of saving lives and protecting property.”
"Severe weather and emergencies can happen at any moment, which is why individuals and communities need to be prepared today," said FEMA Deputy Administrator Erik A. Hooks. "Already, we are seeing storms move across the country that can bring additional hazards like tornadoes, flooding and hail. Taking a proactive approach to our increasingly challenging climate landscape today can make a difference in how people can recover tomorrow."
As one of the strongest El Ninos ever observed nears its end, NOAA scientists predict a quick transition to La Nina conditions, which are conducive to Atlantic hurricane activity because La Nina tends to lessen wind shear in the tropics. At the same time, abundant oceanic heat content in the tropical Atlantic Ocean and Caribbean Sea creates more energy to fuel storm development.
This hurricane season also features the potential for an above-normal west African monsoon, which can produce African easterly waves that seed some of the strongest and longer-lived Atlantic storms. Finally, light trade winds allow hurricanes to grow in strength without the disruption of strong wind shear, and also minimize ocean cooling. Human-caused climate change is warming our ocean globally and in the Atlantic basin, and melting ice on land, leading to sea level rise, which increases the risk of storm surge. Sea level rise represents a clear human influence on the damage potential from a given hurricane.
Enhanced communications in store for 2024 season
NOAA will implement improvements to its forecast communications, decision support and storm recovery efforts this season. These include:
New tools for hurricane analysis and forecasting this year
System upgrades in operation
NOAA will upgrade its observing systems critical in understanding and forecasting hurricanes. These projects will provide more observations of the ocean and atmosphere in the Caribbean, the Gulf of Mexico, on the U.S. East Coast and in the tropical Atlantic.
About NOAA seasonal outlooks NOAA’s outlook is for overall seasonal activity and is not a landfall forecast. In addition to the Atlantic seasonal outlook, NOAA also issues seasonal hurricane outlooks for the eastern Pacific , central Pacific and western north Pacific hurricane basins.
NOAA’s Climate Prediction Center will update the 2024 Atlantic seasonal outlook in early August, prior to the historical peak of the season.
Climate, weather, and water affect all life on our ocean planet. NOAA’s mission is to understand and predict our changing environment, from the deep sea to outer space, and to manage and conserve America’s coastal and marine resources.
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COMMENTS
Frank breech. When a baby's feet or buttocks are in place to come out first during birth, it's called a breech presentation. This happens in about 3% to 4% of babies close to the time of birth. The baby shown below is in a frank breech presentation. That's when the knees aren't bent, and the feet are close to the baby's head.
The cephalic position is when a fetus is head down when it is ready to enter the birth canal. This is one of a few variations of how a fetus can rest in the womb and is considered the ideal one for labor and delivery. About 96% of babies are born in the cephalic position. Most settle into it between the 32nd and 36th weeks of pregnancy.
Occiput or cephalic anterior: This is the best fetal position for childbirth. It means the fetus is head down, facing the birth parent's spine (facing backward). Its chin is tucked towards its chest. The fetus will also be slightly off-center, with the back of its head facing the right or left. This is called left occiput anterior or right ...
If the fetus is in a different position, lie, or presentation, labor may be more difficult, and a normal vaginal delivery may not be possible. Variations in fetal presentation, position, or lie may occur when. The fetus is too large for the mother's pelvis (fetopelvic disproportion). The uterus is abnormally shaped or contains growths such as ...
Most babies settle into their final position somewhere between 32 to 36 weeks gestation. Head Down, Facing Down (Cephalic Presentation) This is the most common position for babies in-utero. 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 ...
This is called cephalic presentation. 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).
In breech presentation, the presenting part is a poor dilating wedge, which can cause the head to be trapped during delivery, often compressing the umbilical cord. 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.
The vast majority of fetuses at term are in cephalic presentation. Approximately 5 percent of these fetuses are in a cephalic malpresentation, such as occiput posterior or transverse, face ( figure 1A-B ), or brow ( figure 2) [ 1 ]. Diagnosis and management of face and brow presentations will be reviewed here.
If your baby is headfirst, the 3 main types of presentation are: anterior - when the back of your baby's head is at the front of your belly. lateral - when the back of your baby's head is facing your side. posterior - when the back of your baby's head is towards your back. Top row: 'right anterior — left anterior'.
Right occiput anterior: The position is the same as that above, but the fetus is in the womb's right side. Posterior: The head is down, and the back is in line with the pregnant person's ...
Benefits of Cephalic Presentation in Pregnancy. Cephalic presentation is one of the most ideal birth positions, and has the following benefits: It is the safest way to give birth as your baby's position is head-down and prevents the risk of any injuries. It can help your baby move through the delivery canal as safely and easily as possible.
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 first enters the birth canal). All other presentations are abnormal (malpresentations ...
The fetus enters the pelvis in a cephalic presentation approximately 95 percent to 96 percent of the time. In these cephalic presentations, the occiput may be in the persistent transverse or posterior positions. In about 3 percent to 4 percent of pregnancies, there is a breech-presenting fetus (see Chapter 25).
Breech and transverse presentations should be converted to cephalic presentations by external cephalic version or delivered by cesarean section. Face, brow, and compound presentations are usually managed expectantly. ... They found that at 21 to 24 weeks' gestation, 33.3% of fetuses were in the breech position. By contrast, only 6.7% of fetuses ...
Introduction. Cephalic presentation is the most physiologic and frequent fetal presentation and is associated with the highest rate of successful vaginal delivery as well as with the lowest frequency of complications 1.Studies on the frequency of breech presentation by gestational age (GA) were published more than 20 years ago 2, 3, and it has been known that the prevalence of breech ...
Cephalic presentation means a fetus is in a head-down position. Vertex refers to the fetus's neck being tucked in. There are other types of cephalic presentations like brow and face. These mainly describe how the fetus's neck is flexed. ... It's possible for a fetus to rotate into a cephalic presentation after 36 weeks.
Description of the condition. Cephalo‐pelvic disproportion (CPD) is one of the leading indications for an emergency caesarean section. CPD occurs when there is a mismatch between the fetal head and the maternal pelvis (when the fetal head is too big for the pelvis), resulting in obstructed labour.
The cephalic index was calculated using the formula: CI = BPD/OFD × 100. The distribution of the CI at both scans is very close to a normal distribution. The mean CI at 17 to 22 weeks was 75.9 (SD, 3.7); the mean CI at 28 to 33 weeks was 77.8 (SD, 3.5). The mean change in CI was 1.9 (SD, 4.28), which is not statistically significantly ...
This positioning is referred to as cephalic presentation. ... It is normal for the mother to be gaining around one pound each week at this stage. ... 29 - 32 weeks. News-Medical, viewed 31 May ...
1/1 people found this helpful. cephalic presentation is the presentation in which the head present first ..If you're trying for normal vaginal delivery then this is the favourable position... however if you are delivering earlier ... Read More. Cephalic presentation seen at my last scan. I am 24 weeks pregnant.
I think they flip so much at this stage because there is so much room. I can feel pressure sometimes and think he must be head down during those times. I see a high risk and he's never said it was an issue. Baby was head down for my ultrasound at 20 week they asked me to come 2 weeks later baby had flipped.
Forecasters have a 70% confidence in these ranges. The upcoming Atlantic hurricane season is expected to have above-normal activity due to a confluence of factors, including near-record warm ocean temperatures in the Atlantic Ocean, development of La Nina conditions in the Pacific, reduced Atlantic trade winds and less wind shear, all of which ...