Singh 2009

Methods	4‐arm active‐controlled double‐dummy randomised trial.
Participants	Between dates unspecified, 300 parturients were randomised in a hospital setting in India. The population comprised women of unspecified parity, a singleton pregnancy, at low risk for PPH, who delivered by vaginal delivery. Exclusion criteria comprised parturients undergoing augmentation of labour, or those with intrauterine death, antepartum haemorrhage, multiple pregnancy, malpresentation, cardiac disorder, rhesus‐negative mother, hypertension, Hb less than 70 g/L or hypersensitivity/contraindication to prostaglandins.
Interventions	400 mcg or 600 mcg of misoprostol administered sublingually (n = 150) versus 5 IU of oxytocin administered by an intravenous bolus (n = 75) versus 200 mcg of ergometrine administered by an intravenous bolus (n = 75).
Outcomes	The study recorded the following outcomes: PPH at 500, additional uterotonics, transfusion, manual removal of placenta, blood loss (mL), third‐stage duration (min), fever, shivering.
Notes	Contact with study authors for additional information: yes. Additional data from authors: no.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Drug packets were sealed and coded by the same individual using a computer‐generated random number chart.
Allocation concealment (selection bias)	Unclear risk	Investigators used sealed drug packets.
Blinding of participants and personnel (performance bias) All outcomes	Low risk	The study was "double‐blind": active treatments and placebo treatments were "identical" and investigators were "thus blinded."
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Assessors were blinded to treatment allocations.
Objective assessment of blood loss	Low risk	Investigators removed any linen soiled with amniotic fluid, and placed a disposable and absorbent pre‐weighed linen saver sheet with a pre‐weighed polythene bag under the mother to collect blood from the uterine cavity. Any blood clots were expressed from the vagina into the polythene bag, which was then removed and weighed. A fresh pre‐weighed sanitary napkin was applied. Separate swabs were not included in the final calculation (addition of the various gravimetric measurements), that was performed 1 hour after delivery. "The specific gravity of blood being 1.08, the amount of blood lost in mL was equal to the weight in grams."
Incomplete outcome data (attrition bias) All outcomes	Low risk	Data were collected completely from all randomised study participants.
Selective reporting (reporting bias)	Unclear risk	The protocol of the study was unavailable for verification, but not all of the outcomes projected by methodological descriptions were reported as results in the study report (changes in Hb measurements were unspecified beyond textual summary that "all groups showed a slight decrease in mean haemoglobin concentration 24 hours postpartum [maximum decrease of 0.6 g/dL]; however, the difference was not significant [ANOVA, P > 0.05]").
Intention to treat analysis	Low risk	All those who were enrolled and randomly allocated to treatment were included in the analysis, in the groups to which they were randomised.
Funding source	Unclear risk	Source(s) of funding for the study were not reported.