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. Author manuscript; available in PMC: 2014 May 19.
Published in final edited form as: Cochrane Database Syst Rev. 2011 Nov 9;(11):CD007412. doi: 10.1002/14651858.CD007412.pub3

Comparison 1. Active versus expectant management of 3rd stage of labour (all women).

Outcome or subgroup title No. of studies No. of participants Statistical method Effect size
1 Severe primary postpartum haemorrhage (PPH) at time of birth (clinically estimated or measured blood loss ≥ 1000 mL) 3 4636 Risk Ratio (M-H, Random, 95% CI) 0.34 [0.14, 0.87]
   1.1 High-income setting 3 4636 Risk Ratio (M-H, Random, 95% CI) 0.34 [0.14, 0.87]
   1.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
2 Very severe primary PPH at time of birth (clinically estimated or measured blood loss ≥ 2500 mL) 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   2.1 High-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   2.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
3 Maternal mortality 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   3.1 High-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   3.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
4 Maternal Hb < 9 g/dL 24-72 hours postpartum 2 1572 Risk Ratio (M-H, Random, 95% CI) 0.50 [0.30, 0.83]
   4.1 High-income setting 2 1572 Risk Ratio (M-H, Random, 95% CI) 0.50 [0.30, 0.83]
   4.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
5 Admission to neonatal special/intensive care 2 3207 Risk Ratio (M-H, Random, 95% CI) 0.81 [0.60, 1.11]
   5.1 High-income setting 2 3207 Risk Ratio (M-H, Random, 95% CI) 0.81 [0.60, 1.11]
   5.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
6 Neonatal jaundice requiring phototherapy or exchange transfusion 2 3142 Risk Ratio (M-H, Random, 95% CI) 0.96 [0.55, 1.68]
   6.1 High-income setting 2 3142 Risk Ratio (M-H, Random, 95% CI) 0.96 [0.55, 1.68]
   6.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
7 Neonatal polycythaemia treated with dilutional exchange transfusion 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   7.1 High-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   7.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
8 Severe primary PPH after placental delivery and up to 24 hours (clinically estimated or measured blood loss ≥ 1000 mL) 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   8.1 High-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   8.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
9 Severe primary PPH at time of birth and up to 24 hours (clinically estimated or measured blood loss ≥ 1000 mL) 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   9.1 High-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   9.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
10 Primary blood loss ≥ 500 mL at time of birth (clinically estimated or measured) 3 4636 Risk Ratio (M-H, Random, 95% CI) 0.34 [0.27, 0.44]
   10.1 High-income setting 3 4636 Risk Ratio (M-H, Random, 95% CI) 0.34 [0.27, 0.44]
   10.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
11 Primary blood loss ≥ 500 mL after delivery of placenta and up to 24 hours (clinically estimated or measured) 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   11.1 High-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   11.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
12 Primary blood loss ≥ 500 mL at time of birth and up to 24 hours (clinically estimated or measured) 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   12.1 High-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   12.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
13 Mean maternal blood loss (mL) at time of birth (clinically estimated or measured) 2 2941 Mean Difference (IV, Random, 95% CI) -78.80 [-95.96, -61. 64]
   13.1 High-income setting 2 2941 Mean Difference (IV, Random, 95% CI) -78.80 [-95.96, -61. 64]
   13.2 Low-income setting 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
14 Mean maternal blood loss (mL) after delivery of placenta and up to 24 hours (clinically estimated or measured) 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
   14.1 High-income setting 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
   14.2 Low-income setting 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
15 Mean maternal blood loss (mL at time of birth and up to 24 hours (clinically estimated or measured) 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
   15.1 High-income setting 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
   15.2 Low-income setting 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
16 Maternal blood transfusion 4 4829 Risk Ratio (M-H, Random, 95% CI) 0.35 [0.22, 0.55]
   16.1 High-income setting 4 4829 Risk Ratio (M-H, Random, 95% CI) 0.35 [0.22, 0.55]
   16.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
17 Clinical signs of severe blood loss 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   17.1 High-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   17.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
18 Therapeutic uterotonics during third stage and/or within 24 hours 4 4829 Risk Ratio (M-H, Random, 95% CI) 0.19 [0.15, 0.23]
   18.1 High-income setting 4 4829 Risk Ratio (M-H, Random, 95% CI) 0.19 [0.15, 0.23]
   18.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
19 Mean length of third stage 1 1429 Mean Difference (IV, Random, 95% CI) -0.30 [-1.87, 1.27]
   19.1 High-income setting 1 1429 Mean Difference (IV, Random, 95% CI) -0.30 [-1.87, 1.27]
   19.2 Low-income setting 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
20 Manual removal of placenta as defined by authors 4 4829 Risk Ratio (M-H, Random, 95% CI) 1.78 [0.57, 5.56]
   20.1 High-income setting 4 4829 Risk Ratio (M-H, Random, 95% CI) 1.78 [0.57, 5.56]
   20.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
21 Postnatal diastolic blood pressure > 90 mmHg between birth of baby and discharge from the labour ward. 3 4636 Risk Ratio (M-H, Random, 95% CI) 4.10 [1.63, 10.30]
   21.1 High-income setting 3 4636 Risk Ratio (M-H, Random, 95% CI) 4.10 [1.63, 10.30]
   21.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
22 Postnatal vomiting between birth of baby and discharge from the labour ward. 3 4636 Risk Ratio (M-H, Random, 95% CI) 2.47 [1.36, 4.48]
   22.1 High-income setting 3 4636 Risk Ratio (M-H, Random, 95% CI) 2.47 [1.36, 4.48]
   22.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
23 Any analgesia between birth of the baby and discharge from labour ward 1 1429 Risk Ratio (M-H, Random, 95% CI) 2.53 [1.34, 4.78]
   23.1 High-income setting 1 1429 Risk Ratio (M-H, Random, 95% CI) 2.53 [1.34, 4.78]
   23.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
24 Women’s assessment of pain during third stage as reported by authors 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   24.1 High-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   24.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
25 Secondary blood loss/any vaginal bleeding needing treatment (after 24 hhours and up to 6 weeks) 3 4636 Risk Ratio (M-H, Random, 95% CI) 1.10 [0.40, 2.99]
   25.1 High-income setting 3 4636 Risk Ratio (M-H, Random, 95% CI) 1.10 [0.40, 2.99]
   25.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
26 Amount of lochia either estimated or measured after 24 hours and up to discharge from hospital 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
   26.1 High-income setting 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
   26.2 Low-income setting 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
27 Surgical evacuation of retained products of conception 3 4636 Risk Ratio (M-H, Random, 95% CI) 0.74 [0.32, 1.71]
   27.1 High-income setting 3 4636 Risk Ratio (M-H, Random, 95% CI) 0.74 [0.32, 1.71]
   27.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
28 Afterpains - abdominal pain associated with the contracting uterus in the postpartum period. 1 1429 Risk Ratio (M-H, Random, 95% CI) 2.53 [1.34, 4.78]
   28.1 High-income setting 1 1429 Risk Ratio (M-H, Random, 95% CI) 2.53 [1.34, 4.78]
   28.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
29 Apgar score < 7 at 5 minutes 1 1695 Risk Ratio (M-H, Random, 95% CI) 1.00 [0.38, 2.66]
   29.1 High-income setting 1 1695 Risk Ratio (M-H, Random, 95% CI) 1.00 [0.38, 2.66]
   29.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
30 Birthweight 2 3207 Mean Difference (IV, Random, 95% CI) -76.90 [-108.51, -45.30]
   30.1 High-income setting 2 3207 Mean Difference (IV, Random, 95% CI) -76.90 [-108.51, -45.30]
   30.2 Low-income setting 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
31 Neonatal encephalopathy assessed using Sarnat staging (Sarnat 1976; Table 1). 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   31.1 High-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   31.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
32 Neonatal mortality 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   32.1 High-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   32.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
33 Intraventricular haemorrhage - Papille grade III/IV - (for infants born before 34 weeks gestation only) 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   33.1 High-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   33.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
34 Number of infants who received a red blood cell transfusion 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   34.1 High-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   34.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
35 Infant Hb level at 24 to 72 hours 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
   35.1 High-income setting 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
   35.2 Low-income setting 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
36 Infant Hb level at 3-6 months 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
   36.1 High-income setting 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
   36.2 Low-income setting 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
37 Infant iron indices (ferritin) at 3 to 6 months. 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   37.1 High-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   37.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
38 Exclusive breastfeeding at discharge from hospital 1 1695 Risk Ratio (M-H, Random, 95% CI) 1.01 [0.96, 1.07]
   38.1 High-income setting 1 1695 Risk Ratio (M-H, Random, 95% CI) 1.01 [0.96, 1.07]
   38.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
39 Neurodevelopmental, cognitive or developmental outcomes assessed after age 18 months 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   39.1 High-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   39.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
40 Return to hospital as in- or outpatient because of bleeding (not pre-specified) 2 2941 Risk Ratio (M-H, Random, 95% CI) 2.21 [1.29, 3.79]
   40.1 High-income setting 2 2941 Risk Ratio (M-H, Random, 95% CI) 2.21 [1.29, 3.79]
   40.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
41 Postnatal maternal mean Hb (outcome not pre-specified) 3 4062 Mean Difference (IV, Random, 95% CI) 0.52 [0.44, 0.60]
   41.1 High-income setting 3 4062 Mean Difference (IV, Random, 95% CI) 0.52 [0.44, 0.60]
   41.2 Low-income setting 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]