Table 1.

Summary of included studies.

Author, year	Aim	Type of study	Intervention	Outcome
Shakur et al. (2017)	Assess the effects of early administration of TXA on death, hysterectomy and other relevant outcomes in women with PPH.	Double-blind, randomised controlled trial.	Tranexamic acid vs. placebo.	Reduced death resulting from PPH, TXA 1.5% vs. placebo 1.9%, p = 0.045.
Prendiville, Harding, Elbourne, & Stirrat (1988)	Compare effect on fetal and maternal morbidity of routine active management of third stage of labour and expectant management.	Randomised controlled trial.	Active vs. expectant management.	Incidence of PPH, active management 5.9% vs. 17.9% in physiological management.
Prendiville, Elbourne, & McDonald (2000)	Assess the effects of active vs. expectant management on blood loss, PPH and other maternal and perinatal complications of the third stage of labour.	Systematic review and meta-analysis.	Randomised trials comparing active vs. expectant management.	Compared to expectant management, active management – PPH > 500 ml – RR 0.38, 95% CI 0.32 to 0.46, maternal blood loss (weighted mean difference −79.33 ml, 95% CI −94.29 to −64.37).
Nørdstrom, Fogelstam, Fridman, Larson, & Rydhstroem (1997)	Compare IV oxytocin administration with saline solution in the management of PPH in the third stage of labour.	Double-blind, randomised controlled trial.	Oxytocin (Partocon 10 IU) vs. 0.9% saline solution.	Oxytocin associated with significant reduction in mean total blood loss (407 vs. 527 ml), frequencies of PPH > 800 ml (8.8% vs. 5.2%), additional treatment with metylergometrine (7.8% vs. 13.8%), postpartum Hb < 10 g/dL (9.7% vs. 15.2%), non-significant increase in frequency of manual placenta removal (3.5% vs. 2.3%).
Sheehan et al. (2011)	Determine effects of adding an oxytocin infusion to bolus oxytocin on blood loss at elective caesarean section.	Double-blind, randomised controlled trial.	Intravenous slow 5 IU oxytocin bolus over 1 minute + additional 40 IU oxytocin infusion in 500 ml of 0.9% saline over 4 hours vs. 5 IU oxytocin bolus over 1 minute + 500 ml of 0.9% saline over 4 hours.	Lower need for additional uterotonic agent in intervention group (12.2% vs. 18.4%), no difference in occurrence of major obstetric haemorrhage between groups (bolus + infusion 15.7% vs. bolus only 16.0%, adjusted OR 0.98, 95% CI 0.77 to 1.25, p = 0.86).
McDonald, Abbott, & Higgins (2004)	Compare the effects of ergometrine-oxytocin with oxytocin in reducing the risk of PPH (blood loss of > 500 ml) and other maternal and neonatal outcomes.	Systematic review and meta-analysis.	Randomised trials comparing ergometrine-oxytocin vs. oxytocin use in third stage of labour managed actively.	Compared with oxytocin, ergometrine-oxytocin was associated with a reduction in risk of PPH (OR 0.82, 95% CI 0.71 to 0.95).
Cotter, Ness, & Tolosa (2001)	Compare effects of oxytocin given prophylactically in third stage of labour on maternal and neonatal outcomes.	Systematic review and meta-analysis.	Randomised or quasi-randomised controlled trials including women anticipating vaginal delivery where oxytocin was given prophylactically for the third stage of labour.	In 7 trials, prophylactic oxytocin reduced blood loss > 500 ml (RR 0.50, 95% CI 0.43 to 0.59) and need for therapeutic oxytocics (RR 0.50, 95% CI 0.39 to 0.64). In 6 trials, little evidence of differential effects for oxytocin vs. ergot alkaloids except oxytocin associated with fewer manual removals of placenta (RR 0.57, 95% CI 0.41 to 0.79). In 5 trials, little evidence of synergistic effect of adding oxytocin to ergometrine vs. ergometrine.
Yuen, Chan, Yim, & Chang (1995)	Compare effect of IM syntometrine and syntocinon in the management of third stage of labour.	Double-blind, randomised prospective trial.	IM syntometrine vs. IM syntocinon.	Syntometrine reduced blood loss postpartum and risk of PPH (OR 0.60, 95% CI 0.21 to 0.88) and need for repeat oxytocin injections (OR 0.63, 95% CI 0.44 to 0.89). Higher incidence of manual removal of placenta when using syntometrine (OR 3.7, 95% CI 1.03 to 1.23).
Gülmezoglu et al. (2001)	Determine whether oral misoprostol is as effective as oxytocin during third stage of labour.	Double-blind, randomised controlled trial.	600 microgram misoprostol orally vs. 10 IU oxytocin IV or IM, in vaginal deliveries.	PPH > 1000 ml greater when given misoprostol (4% vs. 3%, RR 1.39, 95% CI 1.19 to 1.63, p < 0.0001), greater need for additional uterotonics (15% vs. 11%, RR 1.40, 95% CI 1.29 to 1.51, p < 0.0001).
Ng et al. (2001)	Compare effect of oral misoprostol and IM syntometrine in the management of the third stage of labour.	Randomised controlled trial.	600 microgram misoprostol vs. 1 ml syntometrine (500 microgram ergometrine + 5 IU oxytocin).	No significant difference in mean blood loss, incidence of PPH or the fall in Hb concentration. The need for additional oxytocic agents higher in misoprostol group (RR 1.62, 95% CI 1.34–1.96), although manual removal of placenta was reduced (RR 0.29, 95% CI 0.09–0.87).
Li, Gong, Dong, Xie, & Dai (2017)	Assess the efficacy and safety of tranexamic acid in reducing blood loss and lowering transfusion needs for patients undergoing caesarean section or vaginal delivery.	Systematic review and meta-analysis.	Randomised trials comparing IV use of TXA in the intervention group and normal saline or 5% glucose in the control group, in all participants with a singleton pregnancy who underwent an elective caesarean section or intended to deliver vaginally.	TXA results in lower total blood loss in caesarean (154.25 ml, 95% CI −182.04 to −126.47, p < 0.00001) and vaginal deliveries (84.79 ml, 95% CI –109.93 to −59.65, p < 0.00001).