Summary of findings for the main comparison. Assessment compared to direct admission in early labour for improving birth outcomes.
| Assessment compared with direct admission in early labour for improving birth outcomes | ||||||
| Patient or population: healthy pregnant women Setting: large hospital in Canada (high resource setting), study published 1996 Intervention: assessment Comparison: direct admission to hospital in early labour | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with direct admission in early labour | Risk with assessment | |||||
| Length of labour (hours) | The mean length of labour (hours) was 8.3 hours in the intervention group and 13.5 hours in the control group | MD 5.2 lower (7.06 lower to 3.34 lower) | ‐ | 209 (1 RCT) | ⊕⊕⊝⊝ LOW 1, 2 | This outcome relates to the length of labour in hospital |
| Rate of caesarean section | Study population | RR 0.72 (0.30 to 1.72) | 209 (1 RCT) | ⊕⊝⊝⊝ VERY LOW 1, 3 | ||
| 106 per 1000 | 76 per 1000 (32 to 182) | |||||
| Rate of instrumental vaginal birth | Study population | RR 0.86 (0.58 to 1.26) | 209 (1 RCT) | ⊕⊝⊝⊝ VERY LOW 1, 3 | ||
| 356 per 1000 | 306 per 1000 (206 to 448) | |||||
| Serious maternal morbidity | Study population | ‐ | (0 RCTs) | ‐ | Serious maternal morbidity was not reported | |
| see comment | See comment | |||||
| Use of epidural or any regional anaesthesia | Study population | RR 0.87 (0.78 to 0.98) | 209 (1 RCT) | ⊕⊕⊝⊝ LOW 1, 2 | ||
| 904 per 1000 | 786 per 1000 (705 to 886) | |||||
| Neonatal admission to special care | Study population | |||||
| see comment | See comment | |||||
| Apgar score < 7 at 5 minutes | Study population | RR 2.97 (0.12 to 72.12) | 209 (1 RCT) | ⊕⊝⊝⊝ VERY LOW 1, 4 | ||
| 0 per 1000 | 0 per 1000 (0 to 0) | |||||
| *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). CI: confidence interval; RCT: randomized controlled trial; RR: risk ratio; | ||||||
| GRADE Working Group grades of evidence High quality: we are very confident that the true effect lies close to that of the estimate of the effect 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 Low quality: our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect 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 | ||||||
1 Single trial with design limitations (lack of blinding) (‐1)
2 Single trial with small sample size (‐1)
3 Wide 95% CI crossing the line of no effect and small sample size (‐2)
4 Wide 95% CI crossing the line of no effect, small sample size and low event rate (‐2)