Damevski 2011.

Study characteristics
Methods	RCT
Participants	40 women Inclusion criteria: ASA I, women aged 21‐28 years with normal pregnancies, elective caesarean for breech presentation, cephalopelvic disproportion, re‐operation Exclusion criteria: body weight > 90 kg, women who refused caesarean Setting: Macedonia
Interventions	Ephedrine infusion versus crystalloid preload Group 1: ephedrine: continuous fast‐drop infusion of 500 mL Ringer's solution with 50 mL ephedrine, commenced immediately after venous cannulation for spinal anaesthesia, and continued until the umbilical cord was clamped Group 2: crystalloid: 20 mL/kg Ringer's solution, warmed to room temperature, commenced 20‐30 min prior to spinal anaesthesia, and continued until the umbilical cord was clamped All women received a standardised spinal anaesthetic technique and dose, standardised oxygen therapy, and standardised oxytocin regimen. Hypotension requiring intervention received 5 mg IV boluses of ephedrine in group 1 (ephedrine group) and 10 mg IV boluses of ephedrine in group 2 (crystalloid group).
Outcomes	Maternal: hypotension; quantity of crystalloid; quantity of ephedrine; nausea and vomiting Neonatal: Apgar scores
Notes	Hypotension defined as SBP < 100 mmHg
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	"Randomised" – no further details reported
Allocation concealment (selection bias)	Unclear risk	As above
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Not reported
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not reported
Incomplete outcome data (attrition bias) All outcomes	Low risk	No losses to follow‐up
Selective reporting (reporting bias)	Unclear risk	Not all outcomes available (e.g. Apgar scores presented only as medians)
Other bias	Low risk	Similar baseline characteristics