Summary of findings 2. Oxytocin compared to ergot alkaloids for the third stage of labour to prevent postpartum haemorrhage.
| Oxytocin compared to ergot alkaloids for the third stage of labour to prevent postpartum haemorrhage | ||||||
| Patient or population: women in the third stage of labour Setting: hospital labour wards and home births in the Netherlands, Sweden, South Africa, Japan, Singapore, India, Nepal, Tunisia, Nigeria, New Zealand, the UK and the USA Intervention: oxytocin Comparison: ergot alkaloids | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with ergot alkaloids | Risk with oxytocin | |||||
| Blood loss 500 mL or more after delivery | Study population | RR 0.84 (0.56 to 1.25) | 3082 (10 RCTs) | ⊕⊝⊝⊝ VERY LOW 1 2 | ||
| 116 per 1000 | 97 per 1000 (65 to 145) | |||||
| Need for additional uterotonics | Study population | RR 0.89 (0.43 to 1.81) | 2178 (8 RCTs) | ⊕⊝⊝⊝ VERY LOW 2 3 4 | ||
| 94 per 1000 | 84 per 1000 (40 to 170) | |||||
| Maternal all‐cause mortality | Study population | ‐ | ‐ | ‐ | This outcome was not reported in any of the included studies. | |
| ‐ | ‐ | |||||
| Blood loss 1000 mL or more after delivery | Study population | RR 1.13 (0.63 to 2.01) | 1577 (3 RCTs) | ⊕⊝⊝⊝ VERY LOW 1 2 | ||
| 32 per 1000 | 36 per 1000 (20 to 64) | |||||
| Blood transfusion | Study population | RR 1.37 (0.34 to 5.51) | 1578 (7 RCTs) | ⊕⊝⊝⊝ VERY LOW 3 5 6 | ||
| 13 per 1000 | 18 per 1000 (4 to 71) | |||||
| Third stage > 30 minutes | Study population | RR 4.69 (1.63 to 13.45) | 450 (2 RCTs) | ⊕⊕⊕⊝ MODERATE 7 | ||
| 18 per 1000 | 84 per 1000 (29 to 240) | |||||
| Diastolic blood pressure > 100 mm Hg between delivery of the baby and discharge from the labour ward | Study population | RR 0.28 (0.04 to 2.05) | 960 (3 RCTs) | ⊕⊕⊝⊝ LOW 6 8 | ||
| 44 per 1000 | 12 per 1000 (2 to 90) | |||||
| *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; RR: Risk ratio; | ||||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: 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 certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1 Studies with serious methodological limitations in multiple domains (risk of bias ‐2)
2 Wide 95% confidence intervals including line of no effect (imprecision ‐1)
3 Studies with serious methodological limitations (risk of bias ‐1)
4 Large variations in effect and non‐overlapping 95% confidence intervals; I2 = 79% indicating substantial heterogeneity (inconsistency ‐1)
5 Large variations in effect; I2 = 45% indicating substantial heterogeneity (inconsistency ‐1)
6 Wide 95% confidence intervals including line of no effect, and few events (imprecision ‐1)
7 Wide 95% confidence interval and few events, including one study with no events (imprecision ‐1)
8 Unclear allocation concealment in majority of studies (risk of bias ‐1)