Summary of findings for the main comparison. Prophylactic oxytocin injection (delivered by community health officer) versus control (no injection) for preventing postpartum haemorrhage.
| Prophylactic oxytocin injection (delivered by community health officer (CHO)) versus control (no injection) for preventing postpartum haemorrhage | ||||||
|
Patient or population: pregnant women giving birth in non‐facility settings Settings: rural districts in a low‐income country (Ghana) Intervention: one injection of oxytocin [10 IU] administered by a CHO) one minute after birth Comparison: no provision of prophylactic oxytocin | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| control | oxytocin | |||||
|
Severe postpartum haemorrhage (> 1000 mL) [follow‐up] |
9.02 per 1000 | 1.46 per 1000 (0.18 to 11.73) | RR 0.16 (0.02 to 1.30) | 1569 (1) | ⊕⊝⊝⊝ very low1 | |
| Severe maternal morbidity | It was not possible to obtain effect estimates as there were no events reported | 1586 (1) |
⊕⊝⊝⊝ very low1 | |||
| Maternal deaths | It was not possible to obtain effect estimates as there were no events reported | 1586 (1) |
⊕⊝⊝⊝ very low1 | |||
|
Postpartum haemorrhage (PPH greater or equal to 500 mL) [follow‐up] |
55.2 per 1000 | 26.4 per 1000 (15.5 to 44.7) | RR 0.48 (0.28 to 0.81) | 1574 (1) | ⊕⊕⊝⊝ low2 | |
|
Postpartum haemorrhage (adjusted by design effect) [follow‐up] |
55.7 per 1000 | 27.5 per 1000 (15.0 to 50.1) | RR 0.49 (0.27 to 0.90) | 1574 (1) | ⊕⊕⊝⊝ low2 | |
|
Transfer or referral to health facility [follow‐up] |
14.5 per 1000 | 10.5 per 1000 (4.93 to 22.6) | RR 0.72 (0.34 to 1.56) | 1586 (1) | ⊕⊕⊝⊝ low2 | |
|
Stillbirths [follow‐up] |
16.4 per 1000 | 20.9 per 1000 (10.9 to 39.4) | RR 1.27 (0.67 to 2.40) | 2006 (1) | ⊕⊕⊝⊝ low2 | |
|
Early infant death (0‐3 days) [follow‐up] |
6.50 per 1000 | 6.72 per 1000 (2.28 to 20.0) | RR 1.03 (0.35 to 3.07) | 1969 (1) | ⊕⊕⊝⊝ low2 | |
| *The basis for the assumed risk (e.g. the median control group risk across studies) 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 Downgraded because of serious methodological limitations (risk of attrition and recruitment bias) and very serious imprecision
2 Downgraded because of serious methodological limitations (risk of attrition and recruitment bias) and serious imprecision