Alahuhta 1992.

Study characteristics
Methods	RCT
Participants	19 women Inclusion criteria: healthy women undergoing elective caesarean under spinal anaesthesia (38‐42 weeks' gestation) for fetal breech presentation or cephalopelvic disproportion in otherwise uncomplicated singleton pregnancies Exclusion criteria: not reported Setting: Finland
Interventions	Ephedrine versus phenylephrine Group 1 (n = 9): ephedrine (mean 27.9 mg, range 16.7 to 32.5) Group 2 (n = 8): phenylephrine (mean 488 µg, range 334 to 767) Standardised anaesthetic technique for all women but variable heavy 0.5% bupivicaine dose (range 2.3‐2.6 mL)
Outcomes	Maternal: hypotension (defined as a fall in SAP of more than 10 mmHg from baseline); heart rate Neonatal: arterial umbilical blood < pH 7.2; Apgar < 8 at 5 min; fetal heart rate; birthweight
Notes	Hypotension requiring intervention: not stated
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Not reported
Allocation concealment (selection bias)	Unclear risk	Not reported
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Described as "double blind" – third‐party preparation and coding of solutions
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not reported
Incomplete outcome data (attrition bias) All outcomes	Low risk	Losses to follow‐up: 2/19 – 1 from each group; 1 technical failure, 1 maternal bradycardia requiring atropine treatment
Selective reporting (reporting bias)	Unclear risk	Not all expected outcomes were reported
Other bias	High risk	Similar baseline characteristics Variable dose of local anaesthetic used for spinal anaesthesia