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Table 4 Blood loss greater than 1000 mL

From: Prophylactic management of postpartum haemorrhage in the third stage of labour: an overview of systematic reviews

Intervention and comparison intervention

Anticipated absolute effects* (95% CI)

Relative effect (95%CI)

Number of participants (studies)

Quality of the evidence (GRADE)

Comments

Risk with comparison

Risk with intervention

Active management

 McCormick 2002 [48] Active versus physiological management of third stage of labour

30 per 1000

11 per 1000 (7–17)

RR 0.36 (0.23–0.57)

4855 (3 studies)

Very low

Serious risk of bias, serious inconsistency, serious imprecision

 Begley 2015 [21] Active versus expectant management of third stage of labour

24 per 1000

8 per 1000 (3–21)

RR 0.34 (0.14–0.87)

4636 (3 studies)

Very low

Serious risk of bias, serious inconsistency, serious imprecision

 Du 2014 [47] Active management with CCT versus without CCT

20 per 1000

19 per 1000 (16–22)

RR 0.91 (0.77–1.08)

27,454 (3 studies)

Low

Serious risk of bias, serious inconsistency, serious imprecision

Oxytocin

 Westhoff 2013 [29] Prophylactic oxytocin versus placebo

48 per 1000

30 per 1000 (21–42)

RR 0.62 (0.44–0.87)

4162 (5 studies)

Moderate

Serious risk of bias

 Soltani 2010 [27] Use of oxytocics before versus after delivery of placenta

194 per 1000

191 per 1000 (93–385)

RR 0.98 (0.48–1.98)

130 (1 study)

Low

Evidence based on a single study

 Pantoja 2016 [51] Oxytocin injection in thigh versus no injection

9 per 1000

1 per 1000 (0–12)

RR 0.16 (0.02–1.30)

1569 (1 study)

Very low

Serious risk of bias, serious imprecision

Prostaglandin

 Joy 2003 [53] Oral misoprostol (400–600 mcg) versus placebo

85 per 1000

79 per 1000 (56–109)

OR 0.34 (0.64–1.33)

1505 (3 studies)

Low

Serious inconsistency, Serious imprecision

 Joy 2003 [53] Rectal misoprostol (400 mcg) versus placebo

70 per 1000

48 per 1000 (24–95)

OR 0.67 (0.33–1.39)

542 (1 study)

Moderate

Evidence based on a single study

 Langenbach 2006 [54] Oral or rectal misoprostol (400–600 mcg) versus placebo

83 per 1000

70 per 1000 (52–94)

RR 0.85 (0.63–1.14)

2112 (5 studies)

Very low

Serious risk of bias, serious inconsistency, serious imprecision

 Hofmeyr 2009 [52] Oral or sublingual misoprostol (600 mcg) versus placebo

48 per 1000

44 per 1000 (26–75)

RR 0.92 (0.54–1.57)

4914 (5 studies)

Moderate

Serious inconsistency

 Hofmeyr 2009 [52] Oral or rectal misoprostol (400 mcg) versus placebo

51 per 1000

41 per 1000 (24–70)

RR 0.80 (0.47–1.37)

3039 (5 studies)

Low

Serious inconsistency, serious imprecision

 Tunçalp 2012 [32] Rectal misoprostol (400 mcg) versus placebo or no uterotonics

70 per 1000

48 per 1000 (24–96)

RR 0.69 (0.35–1.37)

542 (1 study)

Moderate

Evidence based on a single study

 Tunçalp 2012 [32] Sublingual misoprostol (600 mcg) versus placebo or no uterotonics

169 per 1000

112 per 1000 (76–166)

RR 0.69 (0.35–1.37)

661 (1 study)

Moderate

Evidence based on a single study

 Tunçalp 2012 [32] Buccal misoprostol (200 mcg) versus placebo or no uterotonics

123 per 1000

139 per 1000 (81–238)

RR 1.13 (0.66–1.94)

352 (1 study)

Moderate

Evidence based on a single study

 Tunçalp 2012 [32] Prostaglandin versus placebo or no uterotonics

125 per 1000

69 per 1000 (27–169)

RR 0.55 (0.22–1.35)

46 (1 study)

Moderate

Evidence based on a single study

Ergot alkaloids

 Liabsuetrakul 2007 [33] Oral or intravenous ergot alkaloids versus no uterotonics

31 per 1000

10 per 1000 (1–81)

RR 0.32 (0.04–2.59)

1718 (2 studies)

Low

Serious inconsistency, serious imprecision

Tranexamic acid

 Faraoni 2014 [58] Tranexamic acids versus placebo or no treatment

96 per 1000

47 per 1000 (32–71)

RR 0.49 (0.33–0.74)

1754 (4 studies)

Moderate

Serious inconsistency

 Novikova 2015 [59] Tranexamic acids versus placebo or no treatment

37 per 1000

15 per 1000 (9–27)

RR 0.40 (0.23–0.71)

2093 (6 studies)

Moderate

Serious inconsistency

 Ker 2016 [60] Tranexamic acids versus placebo or no treatment

30 per 1000

13 per 1000 (6–28)

RR 0.43 (0.20–0.94)

1400 (2 studies)

Low

Serious risk of bias, serious imprecision

Timing of cord clamping

 McDonald, 2013 [22] Early versus late cord clamping

34 per 1000

35 per 1000(22–56)

RR 1.04 (0.65–1.65)

2066 (5 studies)

Moderate

Serious inconsistency

Uterine massage

 Hofmeyr 2013 [61] Uterine massage versus no massage

2 per 1000

5 per 1000 (0–44)

RR 2.96 (0.31–28.35)

1291 (2 studies)

Low

Serious inconsistency, serious imprecision

  1. GRADE working group grades of evidence
  2. High quality: We are very confident that the true effect lies close to that of the estimate of the effect
  3. 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
  4. Low quality: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect
  5. 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
  6. CI Confidence interval, RR risk ratio
  7. *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)