Summary of findings 1. NSAID compared to placebo for relief of pain due to uterine cramping/involution after birth.
| NSAID compared to placebo for relief of pain due to uterine cramping/involution after birth | |||||
| Patient or population: women who have given birth vaginally, requiring analgesia for after‐birth pains. Setting: hospital obstetric inpatients (USA, Venezuela, and one trial setting unspecified) Intervention: NSAID Comparison: placebo | |||||
| Outcomes | № of participants (studies) | Certainty of the evidence (GRADE) | Relative effect (95% CI) | Anticipated absolute effects* (95% CI) | |
| Risk with placebo | Risk difference with NSAID | ||||
| Adequate pain relief as reported by the woman (5 to 8 hours) |
946 (11 RCTs) | ⊕⊕⊕⊝ MODERATEa | RR 1.66 (1.45 to 1.91) | Study population | |
| 441 per 1000 | 291 more per 1000 (198 more to 401 more) | ||||
| Need for additional pain relief (5 to 8 hours) |
375 (4 RCTs) | ⊕⊕⊝⊝ LOWa,b | RR 0.15 (0.07 to 0.33) | Study population | |
| 160 per 1000 | 136 fewer per 1000 (149 fewer to 107 fewer) | ||||
| Maternal adverse events (4 to 8 hours) |
598 (9 RCTs) | ⊕⊕⊝⊝ LOWa,c | RR 1.05 (0.78 to 1.41) | Study population | |
| 239 per 1000 | 12 more per 1000 (52 fewer to 98 more) | ||||
| Neonatal adverse events | Not reported | ||||
| Duration of hospital stay | Not reported | ||||
| Any breastfeeding at hospital discharge | Not reported | ||||
| Any breastfeeding at 6 weeks postpartum | Not reported | ||||
| *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; | |||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: 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 certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: 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 due to serious concerns about limitations in study design: risk of bias ‐ unclear random sequence generation, allocation concealment, blinding of outcome assessors and selective reporting. bDowngraded one level due to serious concerns about imprecision: few events. cDowngraded one level due to serious concerns about imprecision: wide 95% confidence interval that is consistent with possible harm and possible benefit.