Table 2.
Quality assessment.
| Participants (studies) | Risk of bias | Inconsistency | Indirectness | Imprecision | Publication bias | Overall quality of evidence | Summary of findings | ||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Study event rates (%) | Relative effect (95% CI) | Anticipated absolute effects | |||||||||
| Control | Intervention | Risk with Control | Risk difference with Intervention (95% CI) | ||||||||
| Perineal laceration (critical outcome) | |||||||||||
| 11,372 (35 studies) | No serious | Serious | No serious | No serious | Undetected | ⊕⊕⊕◯ MODERATE due to inconsistency | 2552/5727 (44.6%) | 2689/5645 (47.6%) | OR 0.85 (0.78–0.93) | 40 fewer per 1,000 | From 61 fewer to 18 fewer |
| Intact perineum (important outcome) | |||||||||||
| 8,069 (25 studies) | No serious | Serious | No serious | No serious | Undetected | ⊕⊕⊕◯ MODERATE due to inconsistency | 1194/3985 (30.0%) | 820/3885 (21.1%) | OR 1.63 (1.47–1.81) | 95 more per 1,000 | From 73 more to 118 more |
| 1st degree laceration (important outcome) | |||||||||||
| 8,949 (29 studies) | No serious | Serious | No serious | No serious | Undetected | ⊕⊕⊕◯ MODERATE due to inconsistency | 993/4465 (22.2%) | 897/4484 (20.0%) | OR 1.17 (1.05–1.30) | 26 more per 1,000 | From 8 more to 45 more |
| 2nd degree laceration (important outcome) | |||||||||||
| 8,902 (29 studies) | No serious | Serious | No serious | No serious | Undetected | ⊕⊕⊕◯ MODERATE due to inconsistency | 750/4468 (16.8%) | 885/4434 (20.0%) | OR 0.79 (0.71–0.88) | 35 fewer per 1,000 | From 49 fewer to 20 fewer |
| Severe perineal laceration (critical outcome) | |||||||||||
| 9,154 (23 studies) | No serious | No serious | No serious | No serious | Undetected | ⊕⊕⊕⊕ HIGH | 104/4611 (2.3%) | 224/4543 (4.9%) | OR 0.44 (0.35–0.56) | 27 fewer per 1,000 | From 31 fewer to 21 fewer |
| Episiotomy rate (critical outcome) | |||||||||||
| 8,646 (30 studies) | No serious | Very serious | No serious | No serious | Undetected | ⊕⊕◯◯ LOW due to inconsistency | 1065/4325 (24.6%) | 1349/4321 (31.2%) | OR 0.63 (0.56–0.71) | 90 fewer per 1,000 | From 110 fewer to 68 fewer |
| Perineal pain (mild) (important outcome) | |||||||||||
| 1703 (7 studies) | No serious | Serious | No serious | Serious | Undetected | ⊕⊕⊕⊕ HIGH due to inconsistency, imprecision | 276/859 (32.1%) | 135/844 (16.0%) | OR 3.25 (2.54–4.41) | 229 more per 1,000 | From 160 more to 296 more |
| Perineal pain (moderate) (important outcome) | |||||||||||
| 1703 (7 studies) | No serious | Very serious | No serious | Serious | Undetected | ⊕◯◯◯ VERY LOW due to inconsistency, imprecision | 225/859 (26.2%) | 188/844 (22.3%) | OR 1.24 (0.99–1.55) | 39 more per 1,000 | From 2 fewer to 85 more |
| Perineal pain (severe or more) (important outcome) | |||||||||||
| 1703 (7 studies) | No serious | Very serious | No serious | No serious | Undetected | ⊕⊕⊕⊕ HIGH due to inconsistency | 206/859 (24.0%) | 398/844 (47.2%) | OR 0.30 (0.24–0.37) | 260 fewer per 1,000 | From 295 fewer to 223 fewer |
| 1 min APGAR (important outcome) | |||||||||||
| 2,211 (9 studies) | No serious | No serious | No serious | No serious | Undetected | ⊕⊕⊕⊕ HIGH | 1,124 | 1,087 | – | The mean 1 min APGAR in the intervention groups was 0 higher (−0.05 to 0.05 higher) | |
| 5 min APGAR (important outcome) | |||||||||||
| 2,260 (9 studies) | No serious | Very serious | No serious | Serious | Undetected | ⊕⊕⊕◯ MODERATE due to inconsistency, imprecision | 1,124 | 1,136 | – | The mean 5 min APGAR in the intervention groups was 001 higher (0.02 to 0.04 higher) | |