Summary of findings 3. Colloid versus crystalloid.
| Colloid versus crystalloid for preventing hypotension during spinal anaesthesia for caesarean section | |||||
| Patient or population: women having spinal anaesthesia for caesarean section Setting: hospital settings in Europe, North America, India, and the Middle East Intervention: colloid Comparison: crystalloid | |||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Quality of the evidence (GRADE) | |
| Risk with crystalloid | Risk with colloid | ||||
| Maternal hypotension requiring intervention | Study population | RR 0.69 (0.58 to 0.81) | 2009 (27 RCTs) | ⊕⊝⊝⊝ Very lowa,b,c | |
| 595 per 1000 | 411 per 1000 (345 to 484) | ||||
| Maternal hypertension requiring intervention | Study population | RR 0.64 (0.09 to 4.46) | 327 (3 RCTs) | ⊕⊝⊝⊝ Very lowc,d,e | |
| 55 per 1000 | 35 per 1000 (5 to 246) | ||||
| Maternal bradycardia requiring intervention | Study population | RR 0.98 (0.54 to 1.78) | 413 (5 RCTs) | ⊕⊝⊝⊝ Very lowc,d,e | |
| 87 per 1000 | 86 per 1000 (47 to 156) | ||||
| Maternal nausea and/or vomiting | Study population | RR 0.89 (0.66 to 1.19) | 1058 (14 RCTs) | ⊕⊝⊝⊝ Very lowa,b,c,d,e | |
| 230 per 1000 | 205 per 1000 (152 to 274) | ||||
| Neonatal acidosis as defined by cord or neonatal blood with a pH < 7.2 | Study population | RR 0.83 (0.15 to 4.52) | 678 (6 RCTs) | ⊕⊝⊝⊝ Very lowc,d,e | |
| 26 per 1000 | 21 per 1000 (4 to 116) | ||||
| Neonatal Apgar score < 8 at 5 minutes | Study population | RR 0.24 (0.03 to 2.05) | 730 (10 RCTs) | ⊕⊝⊝⊝ Very lowc,d,e,f | |
| 10 per 1000 | 3 per 1000 (0 to 22) | ||||
| Admission to neonatal intensive care unit | No studies reported this outcome. | ||||
| *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. | |||||
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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. | |||||
aDowngraded one level for serious risk of bias (due to unclear risk of selection bias in most included studies) (−1). bSubstantial heterogeneity (−1). cInclusion criteria not representative of wider population (e.g. elective caesarean section only) (−1). dWide CI (−1). eInadequate sample size (−1). fMultiple studies did not report method of randomisation (−1).