Methods |
Randomised double blind, no further details. Unclear if outcome assessments were blinded. |
Participants |
622 women with vaginal delivery at a university hospital in Halifax, Nova Scotia, Canada. Women with multiple pregnancy, placenta previa, abruptio placentae, coagulation abnormalities, caesarean delivery and asthma were excluded. |
Interventions |
Misoprostol 400 mcg orally after delivery of anterior shoulder vs oxytocin 5 IU IV. |
Outcomes |
Blood loss measured by haematocrit drop greater than 10%, haemoglobin drop greater than 30%, additional uterotonics, blood loss greater than 1000 mL and 500 mL. |
Notes |
Third stage management was 'active'. No mention of postrandomisation exclusion or loss to follow‐up. The authors attribute the high numbers of additional uterotonic use to most women having IV lines during labour and the threshold for bolus oxytocin administration being low. |
Risk of bias |
Bias |
Authors' judgement |
Support for judgement |
Random sequence generation (selection bias) |
Unclear risk |
No mention of how the sequence generation was created. |
Allocation concealment (selection bias) |
Unclear risk |
No mention of how the concealment occurred. |
Blinding (performance bias and detection bias)
All outcomes |
Low risk |
Double‐blind study. |
Incomplete outcome data (attrition bias)
All outcomes |
Low risk |
No mention of postrandomisation exclusion or loss to follow‐up. |
Selective reporting (reporting bias) |
Low risk |
Primary outcomes of the review have been reported. |
Other bias |
Low risk |
The baseline variables among 2 groups are comparable. |