Summary of findings 1. External uterine compression (all methods) plus normal care compared to normal care for treating primary postpartum haemorrhage.

External uterine compression (all methods) compared to normal care for treating primary postpartum haemorrhage
Patient or population: women diagnosed with primary PPH following vaginal birth. PPH was defined as quote: "blood loss > 500mL after delivery" p 601 Setting: hospital setting in Bangkok, Thailand (Chantrapitak 2009) Intervention: external lower uterine compression (either by grasping the uterus through a lax abdominal wall or compressing the uterus against the sacrum and lower vertebrae) for a duration of 10 minutes (plus standard care) Comparison: normal care alone ‐ consisting of "massage, oxytocin (10‐20 units in 1,000 ml of intravenous solution, 200 ml/min), intravenous ergometrine (Methergin®, 0.2 mg), placed cold pack on uterus, and urinary catheterisation" p 601.
Outcomes	Anticipated absolute effects* (95% CI)		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
	Risk with normal care	Risk with external uterine compression (all methods)
Mortality due to bleeding ‐ not reported	See comment					Outcome not reported by trial authors
Hysterectomy to control bleeding ‐ not reported	See comment					Outcome not reported by trial authors
Serious maternal morbidity (renal or respiratory failure, cardiac arrest or multiple organ failure) ‐ not reported	See comment					Outcome not reported by trial authors
Number of women with total blood loss 1000 mL or more after randomisation ‐ not reported	See comment					Outcome not reported by trial authors
Mean blood loss (mL) (trialist defined)	See comment					Outcome not reported by trial authors
Blood transfusion (red cell or whole blood)	Study population		RR 2.33 (0.66 to 8.23)	64 (1 RCT)	⊕⊝⊝⊝ VERY LOW 1 2
	94 per 1000	218 per 1000 (62 to 772)
Side effects of the intervention (e.g. trauma, necrosis) ‐ not reported	See comment					Outcome not reported by trial authors
*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.

¹ We downgraded (1) level for serious limitations in study design (risk of bias)

² We downgraded (2) levels for very serious imprecision due to small sample size, few events and wide confidence interval crossing the line of no effect