Summary of findings 4. Paracetamol compared to placebo for relief of pain due to uterine cramping/involution after birth.
| Paracetamol 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 (Norway, and USA) Intervention: paracetamol 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 paracetamol | ||||
| Adequate pain relief as reported by the woman (6 hours) |
48 (1 RCT) | ⊕⊝⊝⊝ VERY LOWa,b | RR 1.27 (0.80 to 2.00) | Study population | |
| 538 per 1000 | 145 more per 1000 (108 fewer to 538 more) | ||||
| Need for additional pain relief (up to 4 hours) |
75 (1 RCT) | ⊕⊝⊝⊝ VERY LOWa,b | RR 0.74 (0.21 to 2.54) | Study population | |
| 139 per 1000 | 36 fewer per 1000 (110 fewer to 214 more) | ||||
| Maternal adverse events (up to 4 hours and at 6 hours) |
123 (2 RCTs) | ⊕⊝⊝⊝ VERY LOWa,b | RR 2.27 (0.97 to 5.33) | Study population | |
| 97 per 1000 | 123 more per 1000 (3 fewer to 419 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 risk in most domains. bDowngraded two levels due to very serious concerns about imprecision: few participants, few events and wide confidence intervals.