Table 3.
Summary of findings for the second comparison: use of intrauterine balloon tamponade as part of an institutional protocol for the management of refractory PPH (facility‐level intervention)
| Outcome | Study | Effect estimate (95% CI) | Certainty of the evidence (for the effect estimate among all vaginal births) | |
|---|---|---|---|---|
| All vaginal births as denominator | Reported by study authors | |||
| Composite outcome (surgical interventions and/or death) | Anger et al. 2019 | RR a 4.08 (1.07–15.58) | RR a 4.08 (1.07–15.58) |
⨁⨁◯◯ |
| Laas et al. 2012 | RR 0.33 (0.11–1.03) | Not reported |
⨁⨁◯◯ Low g |
|
| Revert et al. 2018 | RR b 0.95 (0.32–2.81) | RR a 0.14 (0.08–0.27) |
⨁⨁◯◯ Low g |
|
| Hysterectomy | Anger et al. 2019 | RR a 4.38 (0.47–41.09) | RR a 4.38 (0.47–41.09) |
⨁◯◯◯ |
| Laas et al. 2012 | RR 0.49 (0.04–5.38) | OR c 0.44 (0.04–4.91) |
⨁◯◯◯ |
|
| Revert et al. 2018 | RR 1.84 (0.44–7.69) | Not reported |
⨁◯◯◯ |
|
| Conservative surgical interventions (CS, AL) | Anger et al. 2019 | RR 2.82 (1.03–7.71) | RR 2.82 (1.03–7.71) |
⨁⨁◯◯ |
| Laas et al. 2012 | RR 0.29 (0.08–1.06) | OR c 0.26 (0.07–0.95) |
⨁⨁◯◯ Low g |
|
| Revert et al. 2018 | RR 0.21 (0.02–1.82) | Not reported |
⨁◯◯◯ |
|
| Maternal death | Anger et al. 2019 | RR a 2.23 (0.35–14.07) | RR a 2.23 (0.35–14.07) |
⨁◯◯◯ |
| Laas et al. 2012 | No events | No events | – | |
| Revert et al. 2018 | Cannot estimate | Not reported | – | |
| Blood transfusion | Anger et al. 2019 | RR a 1.24 (0.86–1.80) | RR a 1.24 (0.86–1.80) |
⨁⨁◯◯ |
| Laas et al. 2012 | RR 1.43 (0.76–2.71) | OR c 1.31 (0.67–2.56) |
⨁◯◯◯ |
|
| Revert et al. 2018 | Not reported | Not reported | — | |
| Transfer–higher level of care | Anger et al. 2019 | RR a 3.05 (0.79–11.70) | RR a 3.05 (0.79–11.70) |
⨁◯◯◯ |
| Laas et al. 2012 | Not reported | Not reported | — | |
| Revert et al. 2018 | Not reported | Not reported | — | |
The effect estimate for the composite outcome reported by the authors in Revert et al. 2018 includes artery embolisations. 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 effect's estimate. Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the effect's estimate, 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 effect's estimate. 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.
AL, artery ligation; CS, compressive sutures.
Adjusted.
In contrast to the composite outcome reported by the study authors, we did not include artery embolisation in the composite outcome for this review.
Study authors used the number of women who required intravenous sulprostone as the denominator.
Downgraded one level due to its wide confidence interval.
Downgraded one level due to high risk of bias on blinding, and unclear risk of bias on random sequence generation and selective reporting.
Downgraded two levels due to its wide confidence interval.
Downgraded two levels because the included studies are non‐randomised studies.