Summary of findings 1. Advance misoprostol distribution/provision to pregnant women for postpartum self‐administration versus usual (or standard) care for prevention of postpartum haemorrhage.
| Advance misoprostol distribution/provision to pregnant women for postpartum self‐administration versus usual (or standard) care for prevention of postpartum haemorrhage | ||||||
| Patient or population: women in the third stage of labour Settings: non‐facility birth settings Intervention: advance misoprostol distribution/provision to pregnant women for postpartum self‐administration Comparison: usual (or standard) care | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Usual (or standard) care | Advance misoprostol distribution/provision to pregnant women for postpartum self‐administration | |||||
| Severe postpartum haemorrhage | See comment | See comment | Not estimable | 299 (1 study) | Not reported | Not reported. |
| Serious maternal morbidity | See comment | See comment | Not estimable | 299 (1 study) | ⊕⊝⊝⊝ very low1,2 | No cases of severe maternal morbidity were recorded among women who had non‐facility births. |
| Maternal death | See comment | See comment | Not estimable | 299 (1 study) | ⊕⊝⊝⊝ very low1,2 | No cases of maternal death were recorded among women who had non‐facility births. |
| Blood transfusion | See comment | See comment | Not estimable | 299 (1 study) | ⊕⊝⊝⊝ very low1,2 | No cases of blood transfusion were recorded among women who had non‐facility births. |
| Women not using/receiving misoprostol at birth | 40 per 1000 | 20 per 1000 (5 to 79) | RR 0.50 (0.13 to 1.95) | 299 (1 study) | ⊕⊝⊝⊝ very low1,3 | |
| Inappropriate use (or misuse) of misoprostol | 0 per 1000 | 0 per 1000 (0 to 0) | RR 4.97 (0.24 to 102.59) | 299 (1 study) | ⊕⊝⊝⊝ very low1,3 | |
| Maternal transfer or referral to a health facility | 20 per 1000 | 13 per 1000 (2 to 79) | RR 0.66 (0.11 to 3.91) | 299 (1 study) | ⊕⊝⊝⊝ very low1,3 | |
| *The basis for the assumed risk is provided in footnotes. The corresponding risk (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 | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 We downgraded (by one level) for serious indirectness because the usual (or standard) care was advance distribution and postpartum self‐administration of inactive study drug. 2 We downgraded (by two levels) for very serious imprecision because there were no events and the sample size was small. 3 We downgraded (by two levels) for very serious imprecision because of few events, small sample size and wide confidence intervals.