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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 2. Active versus expectant management of 3rd stage of labour (women at low risk).

Outcome or subgroup title No. of studies No. of participants Statistical method Effect size
1 Severe primary PPH at time of birth (clinically estimated or measured blood loss ≥ 1000 mL) 2 2941 Risk Ratio (M-H, Random, 95% CI) 0.31 [0.05, 2.17]
   1.1 High-income setting 2 2941 Risk Ratio (M-H, Random, 95% CI) 0.31 [0.05, 2.17]
   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 at 24-72 hr 1 193 Risk Ratio (M-H, Random, 95% CI) 0.17 [0.02, 1.47]
   4.1 High-income setting 1 193 Risk Ratio (M-H, Random, 95% CI) 0.17 [0.02, 1.47]
   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 1 1512 Risk Ratio (M-H, Random, 95% CI) 1.02 [0.55, 1.88]
   5.1 High-income setting 1 1512 Risk Ratio (M-H, Random, 95% CI) 1.02 [0.55, 1.88]
   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 1 1447 Risk Ratio (M-H, Random, 95% CI) 1.31 [0.78, 2.18]
   6.1 High-income setting 1 1447 Risk Ratio (M-H, Random, 95% CI) 1.31 [0.78, 2.18]
   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) 2 2941 Risk Ratio (M-H, Random, 95% CI) 0.33 [0.20, 0.56]
   10.1 High-income setting 2 2941 Risk Ratio (M-H, Random, 95% CI) 0.33 [0.20, 0.56]
   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 the 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 3 3134 Risk Ratio (M-H, Random, 95% CI) 0.30 [0.10, 0.88]
   16.1 High-income setting 3 3134 Risk Ratio (M-H, Random, 95% CI) 0.30 [0.10, 0.88]
   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 3 3134 Risk Ratio (M-H, Random, 95% CI) 0.15 [0.11, 0.21]
   18.1 High-income setting 3 3134 Risk Ratio (M-H, Random, 95% CI) 0.15 [0.11, 0.21]
   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 3 3134 Risk Ratio (M-H, Random, 95% CI) 3.58 [0.42, 30.61]
   20.1 High-income setting 3 3134 Risk Ratio (M-H, Random, 95% CI) 3.58 [0.42, 30.61]
   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. 2 2941 Risk Ratio (M-H, Random, 95% CI) 7.00 [2.99, 16.43]
   21.1 High-income setting 2 2941 Risk Ratio (M-H, Random, 95% CI) 7.00 [2.99, 16.43]
   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. 2 2941 Risk Ratio (M-H, Random, 95% CI) 5.63 [0.69, 46.08]
   22.1 High-income setting 2 2941 Risk Ratio (M-H, Random, 95% CI) 5.63 [0.69, 46.08]
   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 up to 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) 2 2941 Risk Ratio (M-H, Random, 95% CI) 1.78 [0.69, 4.60]
   25.1 High-income setting 2 2941 Risk Ratio (M-H, Random, 95% CI) 1.78 [0.69, 4.60]
   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 2 2941 Risk Ratio (M-H, Random, 95% CI) 0.69 [0.12, 3.98]
   27.1 High-income setting 2 2941 Risk Ratio (M-H, Random, 95% CI) 0.69 [0.12, 3.98]
   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 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   29.1 High-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   29.2 Low-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
30 Birthweight 1 1512 Mean Difference (IV, Random, 95% CI) −67.0 [−114.13, −19. 87]
   30.1 High-income setting 1 1512 Mean Difference (IV, Random, 95% CI) −67.0 [−114.13, −19. 87]
   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 exposed to one or more red blood cell transfusions 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 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   38.1 High-income setting 0 0 Risk Ratio (M-H, Random, 95% CI) 0.0 [0.0, 0.0]
   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) 2 2683 Mean Difference (IV, Random, 95% CI) 0.5 [0.41, 0.59]
   41.1 High-income setting 2 2683 Mean Difference (IV, Random, 95% CI) 0.5 [0.41, 0.59]
   41.2 Low-income setting 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]