Table 1 Characteristics of included systematic reviews
Review title | Date of search | No. studies included | Population | Intervention | Comparison intervention | Outcomes for which data were reported |
|---|---|---|---|---|---|---|
Active management | ||||||
Cochrane review | ||||||
“Fundal pressure versus controlled cord traction as part of the active management of the third stage of labour” (Peña-Martí, 2007 [49]) | August 2010 | No RCTs | N/A | Fundal pressure with routine administration of a uterotonic drug and early cord clamping | Controlled cord traction with routine administration of a uterotonic drug and early cord clamping | Empty review |
“Active versus expectant management for women in the third stage of labour” (Begley, 2015 [21]) | 30 September 2014 | 7 RCTs | 8247 women (vaginal birth at > 24 weeks’ gestation) | Active management of the third stage of labour | Expectant management of the third stage of labour | • Severe PPH (≥ 1000 mL) • Maternal blood transfusion • PPH (≥ 500 mL) • Therapeutic uterotonics |
“Controlled cord traction for the third stage of labour” (Hofmeyr, 2015 [23]) | 29 January 2014 | 3 RCTs | 28,049 women (vaginal birth) | Controlled cord traction with uterotonics | No controlled cord traction with uterotonics | • Maternal death • Severe PPH (≥ 1000 mL) • Maternal blood transfusion • PPH (≥ 500 mL) • Therapeutic uterotonics |
Non-Cochrane review | ||||||
“Preventing postpartum hemorrhage in low-resource settings” (McCormick, 2002 [48]) | September 2001 | 3 RCTs | 4855 women (vaginal birth) | Active management of the third stage of labour | Physiologic management | • Severe PPH (≥ 1000 mL) • Maternal blood transfusion • PPH (≥ 500 mL) • Therapeutic uterotonics |
“Active management of the third stage of labor with and without controlled cord traction: A systematic review and meta-analysis of randomized controlled trials” (Du, 2014 [47]) | 30 October 2013 | 5 RCTs | 30,532 women (vaginal birth) | Controlled cord traction | Hands-off Physiological expulsion of placenta | • Maternal death • Severe PPH (≥ 1000 mL) • Maternal blood transfusion • PPH (≥ 500 mL) • Therapeutic uterotonics |
Pharmacological management (oxytocin) | ||||||
Cochrane review | ||||||
“Prophylactic ergometrine-oxytocin versus oxytocin for the third stage of labour” (McDonald, 2004 [24]) | 30 April 2007 | 6 RCTs | 9332 women (vaginal birth) | Ergometrin-eoxytocin | Oxytocin | • Severe PPH (≥ 1000 mL) • Maternal blood transfusion • PPH (≥ 500 mL) • Therapeutic uterotonics |
“Timing of prophylactic uterotonics for the third stage of labour after vaginal birth” (Soltani, 2010 [27]) | September 2009 | 3 RCTs | 1671 women (vaginal birth) | Intramuscularly or infusion of oxytocin (10 or 20 units), at delivery of the baby’s shoulder, or after the second stage of labour | Intramuscularly or infusion of oxytocin (10 or 20 units), after the birth of placenta | • Severe PPH (≥ 1000 mL) • Maternal blood transfusion • PPH (≥ 500 mL) • Therapeutic uterotonics |
“Umbilical vein injection for the routine management of third stage of labour” (Mori, 2012 [25]) | 31 January 2012 | 9 RCTs | 1118 women (vaginal birth) | Normal saline or uterotonic drugs, or both, via the umbilical cord | Other alternatives (similar agents IV or IM or no injection/placebo) | • Maternal blood transfusion |
“Intramuscular versus intravenous prophylactic oxytocin for the third stage of labour” (Oladapo, 2012 [26]) | 31 December 2011 | No RCTs | N/A | Intramuscular oxytocin | Intravenous oxytocin | Empty review |
“Carbetocin for preventing postpartum haemorrhage” (Su, 2012 [28]) | 1 March 2011 | 11 RCTs | 2635 women (caesarean or vaginal birth) | Oxytocin agonist (carbetocin) | Other uterotonic agents or with placebo or no treatment | • Severe PPH (≥ 1000 mL) • Maternal blood transfusion • PPH (≥ 500 mL) • Therapeutic uterotonics |
“Prophylactic oxytocin for the third stage of labour to prevent postpartum haemorrhage” (Westhoff, 2013 [29]) | 31 May 2013 | 20 RCTs | 10,806 women (vaginal birth) | Prophylactic oxytocin | Placebo or ergot alkaloids | • Maternal death • Severe PPH (≥ 1000 mL) • Maternal blood transfusion • PPH (≥ 500 mL) • Therapeutic uterotonics |
Oxytocin plus ergometrine | Ergot alkaloids | |||||
“Oxytocin for preventing postpartum haemorrhage (PPH) in non-facility birth settings” (Pantoja, 2016 [51]) | 12 November 2015 | 1 RCT | 5919 women (vaginal birth) | Prophylactic oxytocin (any strategy) | No intervention or other uterotonics | • Maternal death • Severe PPH (≥ 1000 mL) • PPH (≥ 500 mL) |
Non-Cochrane review | ||||||
“Carbetocin for the prevention of postpartum hemorrhage: a systematic review and meta-analysis of randomized controlled trials” (Jin, 2016 [50]) | September 2013 | 12 RCTs | 2975 women (caesarean or vaginal birth) | Carbetocin | Other uterotinic agents | • Severe PPH (≥ 1000 mL) • Maternal blood transfusion • Therapeutic uterotonics |
Pharmacological management (prostaglandin) | ||||||
Cochrane review | ||||||
“Advance misoprostol distribution for preventing and treating postpartum haemorrhage” (Oladapo, 2012 [31]) | 5 October 2011 | No RCTs | N/A | Advance misoprostol distribution | Usual care for PPH prevention or treatment | Empty review |
“Prostaglandins for preventing postpartum haemorrhage” (Tunçalp, 2012 [32]) | 7 January 2011 | 72 RCTs | 52,678 women (caesarean or vaginal birth) | Prostaglandin agent in the third stage of labour | Another uterotonic or no prophylactic uterotonic (nothing or placebo) | • Severe PPH (≥ 1000 mL) • Maternal blood transfusion • PPH (≥ 500 mL) • Therapeutic uterotonics |
“Postpartum misoprostol for preventing maternal mortality and morbidity” (Hofmeyr, 2013 [30]) | 11 January 2013 | 78 RCTs | 59,216 women (caesarean or vaginal birth at > 24 weeks’ gestation) | Misoprostol | Placebo/no treatment or other uterotonics | • Maternal death |
Non-Cochrane review | ||||||
“Misoprostol use during the third stage of labor” (Joy, 2003 [53]) | January 1996 to May 2002 | 17 RCTs | 28,170 women (caesarean or vaginal birth) | Misoprostol | Placebo or other uterotonics | • Severe PPH (≥ 1000 mL) • PPH (≥ 500 mL) • Therapeutic uterotonics |
“Misoprostol in preventing postpartum hemorrhage: a meta-analysis” (Langenbach, 2006 [54]) | May 2005 | 22 RCTs | 30,017 women (caesarean or vaginal birth) | Misoprostol | Placebo or oxytocics | • Severe PPH (≥ 1000 mL) • PPH (≥ 500 mL) • Therapeutic uterotonics |
“Misoprostol to prevent and treat postpartum haemorrhage: a systematic review and meta-analysis of maternal deaths and dose-related effects” (Hofmeyr, 2009 [52]) | February 2007 | 46 RCTs | More than 40,000 women (caesarean or vaginal birth) | Misoprostol | Placebo/other uterotonics | • Maternal death • Severe PPH (≥ 1000 mL) • PPH (≥ 500 mL) |
Misoprostol for prevention and treatment of postpartum haemorrhage: a systematic review (Olefile, 2013 [55]) | Unclear | 3 RCTs | 2346 women (vaginal birth) | Misoprostol | Placebo for the prevention and treatment of PPH | • Severe PPH (≥ 1000 mL) • Maternal blood transfusion • PPH (≥ 500 mL) • Therapeutic uterotonics |
Pharmacological management (ergot alkaloid) | ||||||
Cochrane review | ||||||
“Prophylactic use of ergot alkaloids in the third stage of labour” (Liabsuetrakul, 2007 [33]) | 30 April 2011 | 6 RCTs | 1996 women (vaginal birth) | Any ergot alkaloid given prophylactically, by whatever route or timing of administration | No uterotonic agents | • Severe PPH (≥ 1000 mL) • Maternal blood transfusion • PPH (≥ 500 mL) • Therapeutic uterotonics |
Pharmacological management (tranexamic acid) | ||||||
Cochrane review | ||||||
“Tranexamic acid for preventing postpartum haemorrhage” (Novikova, 2015 [59]) | 28 January 2015 | 12 RCTs | 3285 women (caesarean or vaginal birth) | Trenaxamic acid | Placebo or other agents such as uterotonics | • Maternal death • Severe PPH (≥ 1000 mL) • Maternal blood transfusion • PPH (≥ 500 mL) |
Non-Cochrane review | ||||||
“Anti-fibrinolytic agents in postpartum haemorrhage: a systematic review” (Ferrer, 2009 [55]) | November 2008 | 3 RCTs | 461 women (caesarean or vaginal birth) | Tranexamic acid | No treatment | • PPH (≥ 500 mL) |
“Efficacy and safety of tranexamic acid administration for the prevention and/or the treatment of post-partum haemorrhage: A systematic review with meta-analysis” (Faraoni, 2014 [56]) | Unclear (French) | 10 RCTs | 3014 women (caesarean or vaginal birth) | Tranexamic acid | Placebo | • Severe PPH (≥ 1000 mL) • PPH (≥ 500 mL) • Therapeutic uterotonics |
“Prophylactic tranexamic acid in parturients at low risk for post-partum haemorrhage: Systematic review and meta-analysis” (Heesen, 2014 [58]) | 10 May 2013 | 7 RCTs | 1760 women (vaginal birth) | Tranexamic acid | Placebo | • Maternal blood transfusion • PPH (≥ 500 mL) |
“Does tranexamic acid prevent postpartum haemorrhage? A systematic review of randomised controlled trials” (Ker, 2016 [60]) | May 2015 | 26 RCTs | 4191 women (caesarean or vaginal birth) | Tranexamic acid | Placebo or no tranexamic acid | • Maternal death • Severe PPH (≥ 1000 mL) • Maternal blood transfusion • PPH (≥ 500 mL) |
Non-pharmacological management | ||||||
Cochrane review | ||||||
“Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes” (McDonald, 2013 [22]) | 13 February 2013 | 15 RCTs | 3911 women (vaginal birth) | Early cord clamping | Later (delayed) cord clamping | • Severe PPH (≥ 1000 mL) • Maternal blood transfusion • PPH (≥ 500 mL) • Therapeutic uterotonics |
“Uterine massage for preventing postpartum haemorrhage” (Hofmeyr, 2013 [61]) | 30 April 2013 | 2 RCTs | 1964 women (vaginal birth) | Uterine massage commencing after birth of the baby, before or after delivery of the placenta, or both | No intervention or a “dummy” procedure | • Maternal blood transfusion • PPH (≥ 500 mL) • Therapeutic uterotonics |
“Breastfeeding or nipple stimulation for reducing postpartum haemorrhage in the third stage of labour” (Abedi, 2016 [62]) | 15 July 2015 | 4 RCTs | 4608 women (vaginal birth) | Nipple stimulation | No treatment or any uterotonics | • Maternal death • Severe PPH (≥ 1000 mL) • PPH (≥ 500 mL) |