El Behery 2015

Methods	2‐arm active‐controlled double‐dummy randomised trial.
Participants	Between 1st January 2013 and 31st June 2014,180 parturients were randomised in a hospital setting in Egypt. The population comprised nulliparous women with a singleton pregnancy, at high risk for PPH, who delivered by emergency caesarean section. Exclusion criteria comprised parturients undergoing elective caesarean section, vaginal delivery or general anaesthesia, or those who were multigravida, or with malpresentation, fetal anomalies, placenta praevia, diabetes, hypertension, pre‐eclampsia or cardiac disease.
Interventions	100 mcg of carbetocin administered by an intravenous bolus (n = 90) versus 20 IU of oxytocin administered by an intravenous infusion (n = 90).
Outcomes	The study recorded the following outcomes: PPH at 500, PPH at 1000, morbidity, additional uterotonics, transfusion, death, blood loss (mL), change in Hb level, nausea, headache, fever.
Notes	Contact with study authors for additional information: yes. Additional data from authors: yes.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	The randomisation was computer‐generated.
Allocation concealment (selection bias)	Low risk	Investigators used sealed, opaque envelopes.
Blinding of participants and personnel (performance bias) All outcomes	Low risk	The study was "double‐blinded": "a double dummy system for administration was used."
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Assessors were blinded to treatment allocations.
Objective assessment of blood loss	High risk	Investigators evaluated blood loss "in the usual way (visual estimation, number of used swabs and amount of aspirated blood)."
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	"100 cases were excluded (4 had congenital fetal anomalies, 7 cases had placenta praevia, 5 cases were diabetic, 8 had hypertension, 9 had pre‐eclampsia, 3 cases were cardiac, 28 cases [required] general anaesthesia, 17 cases delivered vaginally and 19 delivered by elective caesarean section)."
Selective reporting (reporting bias)	Unclear risk	The protocol of the study was unavailable for verification.
Intention to treat analysis	Unclear risk	The authors did not specify whether 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.