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preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-fip-done" class="wsprkl btn" title="Dismiss find">✘</a></nav><nav id="jr-fip-info-p"><a id="jr-fip-prev" class="wsprkl btn" title="Jump to previuos match">◀</a><button id="jr-fip-matches">no matches yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style"><div class="fm-sec bkr_bottom_sep"><div class="bkr_thumb"><a href="https://www.nice.org.uk" title="National Institute for Health and Care Excellence (NICE)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng137er9-lrg.png" alt="Cover of Evidence reviews for interventions to prevent postpartum haemorrhage in the third stage of labour" /></a></div><div class="bkr_bib"><h1 id="_NBK578069_"><span itemprop="name">Evidence reviews for interventions to prevent postpartum haemorrhage in the third stage of labour</span></h1><div class="subtitle">Twin and Triplet Pregnancy</div><p><b>Evidence review I</b></p><p><i>NICE Guideline, No. 137</i></p><p class="contrib-group"><h4>Authors</h4><span itemprop="author">National Guideline Alliance (UK)</span>.</p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2019 Sep</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-3513-0</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2019.</div></div><div class="bkr_clear"></div></div><div id="ch9.s1"><h2 id="_ch9_s1_">Managing the third stage of labour to reduce postpartum haemorrhage</h2><div id="ch9.s1.1"><h3>Review question</h3><p>What is the optimal method of managing the third stage of labour to reduce the risk of postpartum haemorrhage (PPH) in twin and triplet pregnancy?</p><div id="ch9.s1.1.1"><h4>Introduction</h4><p>Excessive uncontrolled postpartum haemorrhage (PPH) can lead to an increased risk of hysterectomy, multi-organ failure and maternal mortality. Twin and triplet pregnancy is associated with an increased risk of PPH. Prevention of PPH would reduce the need for emergency interventions. This review aims to address the uncertainty around the optimal management of the third stage of labour in twin and triplet pregnancy to reduce the risk of PPH.</p></div><div id="ch9.s1.1.2"><h4>Summary of the protocol</h4><p>See <a class="figpopup" href="/books/NBK578069/table/ch9.tab1/?report=objectonly" target="object" rid-figpopup="figch9tab1" rid-ob="figobch9tab1">Table 1</a> for a summary of the Population, Intervention, Comparison and Outcome characteristics of this review.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch9tab1"><a href="/books/NBK578069/table/ch9.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figch9tab1" rid-ob="figobch9tab1"><img class="small-thumb" src="/books/NBK578069/table/ch9.tab1/?report=thumb" src-large="/books/NBK578069/table/ch9.tab1/?report=previmg" alt="Table 1. Summary of the protocol (PICO Table)." /></a><div class="icnblk_cntnt"><h4 id="ch9.tab1"><a href="/books/NBK578069/table/ch9.tab1/?report=objectonly" target="object" rid-ob="figobch9tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">Summary of the protocol (PICO Table). </p></div></div></div><div id="ch9.s1.1.3"><h4>Methods and process</h4><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overviewing-the-quality-of-the-evidence" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual 2014</a>. Methods specific to this review question are described in the review protocol in <a href="#ch9.appa">appendix A</a> and for a full description of the methods see supplementary document C.</p><p>Declaration of interests were recorded according to NICE’s 2014 conflicts of interest policy from March 2017 until March 2018. From April 2018 onwards they were recorded according to <a href="https://www.nice.org.uk/Media/Default/About/Who-we-are/Policies-and-procedures/declaration-of-interests-policy.pdf" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NICE’s 2018 conflicts of interest policy</a>. Those interests declared until April 2018 were reclassified according to NICE’s 2018 conflicts of interest policy (see Interests Register).</p></div><div id="ch9.s1.1.4"><h4>Clinical evidence</h4><div id="ch9.s1.1.4.1"><h5>Included studies</h5><p>Three studies were identified that met the inclusion criteria for this review (<a class="bibr" href="#ch9.s1.ref1" rid="ch9.s1.ref1">Demetz 2013</a>, <a class="bibr" href="#ch9.s1.ref2" rid="ch9.s1.ref2">Fahmy 2016</a> and <a class="bibr" href="#ch9.s1.ref4" rid="ch9.s1.ref4">Sotillo 2018</a>). One randomised controlled trial (RCT) (<a class="bibr" href="#ch9.s1.ref2" rid="ch9.s1.ref2">Fahmy 2016</a>), 1 prospective cohort study (<a class="bibr" href="#ch9.s1.ref4" rid="ch9.s1.ref4">Sotillo 2018</a>), and 1 retrospective cohort study (<a class="bibr" href="#ch9.s1.ref1" rid="ch9.s1.ref1">Demetz 2013</a>).</p><p>All looked at the effectiveness of one particular uterotonic (carbetocin compared to oxytocin) to prevent or reduce the risk of PPH for women with twin pregnancy during planned or emergency caesarean section (active management in caesarean section). The RCT compared carbetocin (N=30) and oxytocin (N=30) administered slowly over 1 minute, immediately after birth whilst women were under general anaesthetic for planned caesarean section. The prospective cohort study compared a standard protocol of oxytocin within 10–15 minutes of birth (N=86), to the study intervention treatment of carbetocin (N=80) administered in the first minute after birth, for the prevention of PPH in twin pregnancies undergoing caesarean section. The retrospective cohort study compared a standard protocol of oxytocin delivered during the birth of the second baby (N=24) to the same protocol using carbetocin instead (N=39), in women undergoing either planned or emergency caesarean section.</p><p>No evidence was found assessing physiological or active management for vaginal birth.</p><p>The clinical studies included in this evidence review are summarised in <a class="figpopup" href="/books/NBK578069/table/ch9.tab2/?report=objectonly" target="object" rid-figpopup="figch9tab2" rid-ob="figobch9tab2">Table 2</a>.</p><p>See also the literature search strategy in <a href="#ch9.appb">appendix B</a>, study selection flow chart in <a href="#ch9.appc">appendix C</a>, study evidence tables in <a href="#ch9.appd">appendix D</a>, and GRADE profiles in <a href="#ch9.appf">appendix F</a>.</p></div><div id="ch9.s1.1.4.2"><h5>Excluded studies</h5><p>Studies not included in this review with reasons for their exclusion are listed in <a href="#ch9.appk">appendix K</a>.</p></div></div><div id="ch9.s1.1.5"><h4>Summary of clinical studies included in the evidence review</h4><p><a class="figpopup" href="/books/NBK578069/table/ch9.tab2/?report=objectonly" target="object" rid-figpopup="figch9tab2" rid-ob="figobch9tab2">Table 2</a> provides a brief summary of the included studies.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch9tab2"><a href="/books/NBK578069/table/ch9.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figch9tab2" rid-ob="figobch9tab2"><img class="small-thumb" src="/books/NBK578069/table/ch9.tab2/?report=thumb" src-large="/books/NBK578069/table/ch9.tab2/?report=previmg" alt="Table 2. Summary of included studies for twin pregnancy." /></a><div class="icnblk_cntnt"><h4 id="ch9.tab2"><a href="/books/NBK578069/table/ch9.tab2/?report=objectonly" target="object" rid-ob="figobch9tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Summary of included studies for twin pregnancy. </p></div></div><p>Meta-analysis was not conducted due to the different study designs (RCT, retrospective cohort, prospective cohort), and due to the different timings of drug administration (during or after birth).</p><p>See <a href="#ch9.appd">appendix D</a> for the full evidence tables.</p></div><div id="ch9.s1.1.6"><h4>Quality assessment of clinical studies included in the evidence review</h4><p>See <a href="#ch9.appf">appendix F</a> for the full GRADE tables.</p></div><div id="ch9.s1.1.7"><h4>Economic evidence</h4><div id="ch9.s1.1.7.1"><h5>Included studies</h5><p>A systematic review of the economic literature was conducted but no economic studies were identified which were applicable to this review question.</p><p>See the <a href="#ch9.appb">appendix B</a> for the economic search strategy and <a href="#ch9.appg">appendix G</a> for the economic evidence selection flow chart for further information.</p></div><div id="ch9.s1.1.7.2"><h5>Excluded studies</h5><p>No full-text copies of articles were requested for this review and so there is no excluded studies list.</p></div></div><div id="ch9.s1.1.8"><h4>Summary of studies included in the economic evidence review</h4><p>No economic studies were identified which were applicable to this review question.</p></div><div id="ch9.s1.1.9"><h4>Economic model</h4><p>No economic modelling was undertaken for this review because the committee agreed that other topics were higher priorities for economic evaluation.</p></div><div id="ch9.s1.1.10"><h4>Evidence statements</h4><div id="ch9.s1.1.10.1"><h5>Carbetocin versus oxytocin (control) for active management of women with twin pregnancy undergoing caesarean section</h5><div id="ch9.s1.1.10.1.1"><h5>Outcomes for the woman</h5><div id="ch9.s1.1.10.1.1.1"><h5>PPH (blood loss, ml)</h5><p>Very low quality evidence from 1 cohort study (N=63) showed no clinically important difference in blood loss between the intervention (carbetocin) and control (oxytocin) groups.</p></div><div id="ch9.s1.1.10.1.1.2"><h5>Side effects from the drugs – change in mean arterial blood pressure over time (0, 5, 10 minutes after injection of uterotonic drug</h5><p>Moderate quality evidence from 1 RCT (N=60) showed no clinically important difference in mean arterial blood pressure between the intervention (carbetocin) and control (oxytocin) groups.</p></div><div id="ch9.s1.1.10.1.1.3"><h5>Side effects from the drugs – change in mean arterial blood pressure over time (15, 20, 25, 30 minutes after injection of uterotonic drug)</h5><p>High quality evidence from 1 RCT (N=60) showed a clinically important difference in favour of the intervention (carbetocin) group as mean arterial blood pressure remained stable and the oxytocin (control) group’s blood pressure fell (hypotensive).</p></div><div id="ch9.s1.1.10.1.1.4"><h5>Side effects from the drugs – change in mean arterial blood pressure over time (35 minutes after injection of uterotonic drug)</h5><p>Moderate quality evidence from 1 RCT (N=60) showed a clinically important difference in favour of the intervention (carbetocin) group as mean arterial blood pressure remained stable and the oxytocin (control) group’s blood pressure was lower (hypotensive).</p></div><div id="ch9.s1.1.10.1.1.5"><h5>Side effects from the drugs – change in mean arterial blood pressure over time (40, 50, 60 minutes after injection of uterotonic drug)</h5><p>High quality evidence from 1 RCT (N=60) showed a clinically important difference in favour of the intervention (carbetocin) group as mean arterial blood pressure remained stable and the oxytocin (control) group’s blood pressure was lower (hypotensive).</p></div><div id="ch9.s1.1.10.1.1.6"><h5>Need for further treatment (any - anaemia treatment and/or additional uterotonics agents)</h5><p>Low quality evidence from 1 cohort study (N=166) showed a clinically important difference between groups for the need for any further treatment (anaemia treatment and/or additional uterotonics agents) with a higher incidence in the oxytocin (control) group.</p></div><div id="ch9.s1.1.10.1.1.7"><h5>Need for additional uterotonic agents</h5><p>Very low quality evidence from 1 cohort study (N=166) showed no clinically important difference between groups for the need for additional uterotonics agents.</p><p>High quality evidence from 1 RCT (N=60) showed a clinically important difference in the need for additional uterotonic agents in favour of the intervention (carbetocin) group compared to the control (oxytocin) group.</p></div><div id="ch9.s1.1.10.1.1.8"><h5>Blood transfusion</h5><p>Very low quality evidence from 1 cohort study (N=166) showed a clinically important difference between groups for the incidence of blood transfusions with a higher incidence in the oxytocin (control) group.</p><p>Very low quality evidence from 1 cohort study (N=63) showed no clinically important difference in the need for blood transfusion between the intervention (carbetocin) and control (oxytocin) groups.</p><p>Low quality evidence from 1 RCT (N=60) showed no clinically important difference in the need for blood transfusion between the intervention (carbetocin) and control (oxytocin) group.</p></div><div id="ch9.s1.1.10.1.1.9"><h5>Additional treatment required – emergency surgery</h5><p>Very low quality evidence from 1 cohort study (N=63) showed no clinically important difference between the intervention (carbetocin) and the control (oxytocin) groups.</p></div></div></div></div><div id="ch9.s1.1.11"><h4>The committee’s discussion of the evidence</h4><div id="ch9.s1.1.11.1"><h5>Interpreting the evidence</h5><div id="ch9.s1.1.11.1.1"><h5>The outcomes that matter most</h5><p>The committee prioritised PPH as a critical outcome for twin and triplet birth. Prevention of PPH would reduce the need for further interventions. This would improve the woman’s experience in labour and enhance recovery time postpartum. Excessive uncontrolled PPH can lead to an increased risk of hysterectomy, multi-organ failure and maternal mortality. The committee agreed that these were critical outcomes as many women would be well prior to birth. Hysterectomy and multi-organ failure could have long term consequences on the woman’s physical and mental health. PPH was reported as an outcome in 1 study and other studies reported ‘need for additional treatments’ as an outcome.</p><p>Admission to the intensive care unit or high dependency unit were prioritised as important outcomes as they reflect the severe sequelae of PPH. Although, admission into intensive care or high dependency units following birth is relatively rare, PPH remains the leading cause of postnatal admissions (the <a href="https://www.icnarc.org/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Intensive Care National Audit and Research Centre</a>, 2013). Not all birth settings will have an onsite intensive care or high dependency unit, which could potentially delay lifesaving treatment. The committee therefore agreed it was important to choose admission to an intensive care or high dependency unit as an important outcome. Women admitted to intensive care or high dependency units have longer recovery times and may require separation from their babies. This may have long term effects on the woman’s health and bonding with babies. Need for admission to the intensive care unit was not an outcome that was reported.</p><p>The committee agreed that the side effects of uterotonics were important outcomes as they could result in unwanted effects on the woman such as diarrhoea and vomiting. This could affect the overall woman’s experience in labour. However, the committee agreed that the risk of PPH outweighed the potential adverse effects of uterotonics and therefore it was important that uterotonics were administered appropriately. The data on side effects were related only to blood pressure changes which was not considered to be a determining factor in the decision making of the committee.</p><p>Need for blood transfusion was also considered important since it would indicate how much blood loss could be prevented by each strategy. This would therefore have an impact on other outcomes for the woman, such as anaemia and fatigue.</p></div><div id="ch9.s1.1.11.1.2"><h5>The quality of the evidence</h5><p>The quality of the evidence from the included studies was assessed with GRADE. Ratings for evidence from the observational cohort studies were very low, and evidence from the RCT was rated as low to high quality. Study design and risk of bias in the studies were the main factors that lowered the confidence in the evidence. The studies were also relatively small which meant that there was a lot of uncertainty around the estimates which led to evidence being downgraded for imprecision.</p></div><div id="ch9.s1.1.11.1.3"><h5>Benefits and harms</h5><div id="ch9.s1.1.11.1.3.1"><h5>Planning birth: information and support</h5><p>The committee decided, based on their experience and knowledge, that discussions about birth plans are important and that such discussions should enable the woman to make an informed decision about childbirth. At such a life changing time her wishes and preferences should be explored and information should be tailored to each woman. She can then feel better prepared which may ease some of her concerns and anxieties. Such discussions (including managing the third stage of labour) should be conducted at the latest by week 28 of her pregnancy because of the high risk of preterm birth. The committee emphasised that these discussions should be revisited as often as required or desired by the woman, to provide opportunity for her to receive further information and be part of the ongoing decision making process. The committee also acknowledged that the best practice on how to provide information and how to communicate with adults is described in NICE’s guideline on <a href="https://www.nice.org.uk/guidance/cg138" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">patient experience in adult NHS services</a> and cross referred to it.</p></div><div id="ch9.s1.1.11.1.3.2"><h5>Healthcare professionals providing intrapartum care</h5><p>The committee recognised that the core multidisciplinary team recommended by the previous guideline (see <a href="/books/n/niceng137/?report=reader" class="toc-item">recommendation 1.3.1</a>) provides care during the antenatal period and would not be the same team providing intrapartum care. Because intrapartum care was added to the guideline update, based on their knowledge and experience they made a recommendation to clarify that healthcare professionals supporting women when they are giving birth should also have knowledge and experience in multiple pregnancy.</p></div><div id="ch9.s1.1.11.1.3.3"><h5>Assessing risk</h5><p>Based on their expertise and current practice (which is in turn informed by NICE guidance on managing PPH prior to this update), the committee acknowledged that the risk of PPH in women with twin and triplet pregnancy could lead to an increased risk of maternal morbidity, death, multiorgan failure, hysterectomy and blood transfusion and that it is therefore critical to have clear guidance to prevent such serious events. The committee noted that the list of risk factors highlighted in NICE’s guideline on <a href="https://www.nice.org.uk/guidance/cg190/chapter/Recommendations#third-stage-of-labour" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">intrapartum care for healthy women and babies</a> already includes multiple pregnancy (because of over-distension of the uterus and enlarged placenta or placentas) as one of the factors. However, there are many other risk factors that should also be taken into consideration when assessing risk and hence this guideline has been cross-referenced. In this way risk can be stratified according to the individual circumstances of each woman. Assessing the woman’s risks of PPH and having conversations with her about this and all possible management options is a critical aspect of care to identify any particular factors that may raise concerns and to enable the woman to make an informed choice. The process of risk stratification should remain dynamic throughout the intrapartum stage as the woman’s individual risks could change due to events in the intrapartum period.</p></div><div id="ch9.s1.1.11.1.3.4"><h5>Management</h5><p>Based on their expertise and experience the committee noted that a physiological approach to care in the third stage is practised in the UK mostly in midwife-led units and at home births and would therefore be only appropriate for women identified as being at low risk of PPH. They agreed, that twin and triplet pregnancy is a risk factor for PPH and that physiological management of third stage labour is inappropriate and should not be offered. All women should be offered active management of the third stage since it would decrease this risk and / or the need for blood transfusion.</p><p>The committee specifically reviewed evidence from the 3 identified studies on the effectiveness of carbetocin for the management of the third stage of labour in multiple pregnancies. They discussed and agreed to discount the evidence from the prospective cohort study (<a class="bibr" href="#ch9.s1.ref4" rid="ch9.s1.ref4">Sotillo 2018</a>) as it does not compare carbetocin with UK standard recommended active third stage therapy (10 IU oxytocin intramuscular [IM] or 5 IU IV slow bolus). The comparator in this study was high dose and rapid IV infusion and repeated high doses of oxytocin as indicated clinically. Based on expertise and experience, the committee noted that a high dose and rapid infusion of oxytocin are associated with an increased risk of maternal serious adverse effects such as cardiovascular collapse. The committee based this on knowledge of the report of the <a href="https://www.npeu.ox.ac.uk/mbrrace-uk/reports/confidential-enquiry-into-maternal-deaths" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Confidential Enquiries into Maternal Deaths in the UK</a>. Prolonged infusion of high-dose oxytocin may also be associated with water intoxication. Therefore a high dose of oxytocin is contraindicated in clinical practice and the committee agreed that it was an inappropriate control intervention to compare with carbetocin.</p><p>The committee also reviewed the evidence available from the only included RCT (<a class="bibr" href="#ch9.s1.ref2" rid="ch9.s1.ref2">Fahmy 2016</a>). They were concerned by a number of limitations of this study which compared the use of IV carbetocin to 20 IU of oxytocin for the prevention of primary PPH in twin pregnancies delivered by caesarean section. The limitations were the small sample size (N=60) of twin pregnancies, the use of general anaesthetic for all births, the high and rapid IV dose of oxytocin used within the control group and the lack of accurate assessment of blood loss. The retrospective cohort study (<a class="bibr" href="#ch9.s1.ref1" rid="ch9.s1.ref1">Demetz 2013</a>) was also small (N=63), and showed no significant differences between groups. The committee therefore agreed that none of these studies offered conclusive or convincing evidence to support any recommendation for the use of carbetocin in the active management of the third stage of labour in multiple pregnancies.</p><p>All of the identified evidence related to the use of uterotonics in active management of the third stage of labour of women with twin and triplet pregnancies, and more specifically looked at the use of carbetocin compared to oxytocin (control). The committee reviewed this evidence and were also aware of a recently published Cochrane network meta-analysis (NMA) (<a class="bibr" href="#ch9.s1.ref3" rid="ch9.s1.ref3">Gallos 2018</a>), examining multiple uterotonics, including both carbetocin and oxytocin alongside others, to reduce the risk of PPH in the third stage of labour in a mixed population of both singleton and multiple pregnancies (the Cochrane NMA [<a class="bibr" href="#ch9.s1.ref3" rid="ch9.s1.ref3">Gallos 2018</a>] could not be included in this review due to the mixed population of women with singleton or twin pregnancy). However, the findings of the Cochrane NMA (<a class="bibr" href="#ch9.s1.ref3" rid="ch9.s1.ref3">Gallos 2018</a>) remain important due to the size and depth of the analysis. On the basis of the evidence presented in this guideline evidence review, the committee concluded that oxytocin should remain the first-line treatment for the prevention of PPH. This is consistent with the findings of the mixed-population Cochrane review (<a class="bibr" href="#ch9.s1.ref3" rid="ch9.s1.ref3">Gallos 2018</a>) which concluded that no other studied agent is significantly more effective when compared with the reference uterotonic agent oxytocin.</p><p>Due to the limited evidence available specific to women with twin or triplet pregnancy, the committee based the recommendations related to the additional uterotonics on their clinical experience and expertise and decided to make a weaker recommendation for this. They concluded that there was insufficient information to favour one uterotonic over another. The committee agreed based on their experience, where women were identified to have an additional risk factor for PPH over and above that generated by multiple pregnancy, units should refer to local protocols to advise safe choice of additional uterotonics. The committee clarified that local protocols would already be in place for the management of the third stage of labour. The committee also recognised that the side effect profile and contraindications differ amongst individual uterotonics. For this reason, the committee agreed that further uterotonics should be individualised to the woman. The committee concluded that whilst there were side effects to certain uterotonics (for example nausea and vomiting), the benefits of uterotonics outweighed the risks.</p></div><div id="ch9.s1.1.11.1.3.5"><h5>Blood transfusion</h5><p>The committee reiterated the importance of discussions with the woman about what may happen in the event of heavy blood loss, to ensure that all expectant mothers are well informed. As described above, this discussion should include the risks of PPH and management plans, but it should also cover the possible need for blood transfusions. Therefore the potential need for blood products and the transfusion process, in the event of excessive blood loss, should be discussed and documented prior to the intrapartum period.</p><p>The committee concurred that women with twin or triplet pregnancy should have intravenous access sited early in labour with full blood count and group and save. The benefits of having intravenous access in the event of an obstetric emergency are that it allows prompt fluid/blood product resuscitation in the event of a PPH, outweighing potential risks of pain and infection.</p><p>In case of emergency related to PPH, the committee decided, based on their experience, that it would be critical to make sure that the appropriate blood transfusion is readily available.</p><p>Despite the limited evidence, the committee decided to prioritise other areas addressed by the guideline for future research and therefore made no research recommendations.</p></div></div></div><div id="ch9.s1.1.11.2"><h5>Cost effectiveness and resource use</h5><p>In the absence of any economic evidence or original analysis, the committee made a qualitative assessment about the cost effectiveness of recommendations for managing the third stage of labour to reduce the risk of PPH in twin and triplet pregnancy.</p><p>The committee noted that interventions to prevent PPH are relatively inexpensive and that effective treatment would offset future costs by reducing the need for further intervention, including blood transfusions and admission to intensive care. Furthermore, effective treatment reduces the risk of serious adverse outcomes. The committee concluded that active management would be more cost effective than physiological management because it reduces the risk of PPH in twin and triplet pregnancies, which are at an increased risk of this outcome.</p><p>The committee agreed that, because of the risks to health-related quality of life arising from PPH, the benefits of uterotonics outweighed any potential side effects. No evidence was found to suggest any uterotonic agent is significantly more effective than the reference agent oxytocin and therefore considered that oxytocin should remain the first-line treatment for PPH, in line with current practice. In cases where additional uterotonics may be considered for the active management of the third stage of labour, the committee did not think a clear cost-effectiveness case could be made for one uterotonic over another. This reflected both the clinical evidence and the fact that the side effect profile and contraindications of uterotonics differ, which means that the cost-effective choice is often highly individualised.</p></div></div></div><div id="ch9.rl.r1"><h3>References</h3><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="ch9.s1.ref1"><p id="p-120">
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<strong>Demetz 2013</strong>
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</p>Demetz
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J, Clouqueur
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E, D’Haveloose
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A, Staelen
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P, Ducloy
|
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AS, Subtil
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D., Systematic use of carbetocin during cesarean delivery of multiple pregnancies: A before-and-after study, Archives of Gynecology and Obstetrics, 287, 875–880, 2013 [<a href="https://pubmed.ncbi.nlm.nih.gov/23233289" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23233289</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="ch9.s1.ref2"><p id="p-121">
|
|
<strong>Fahmy 2016</strong>
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</p>Fahmy, NG, Yousef, HM, Zaki, HV. Comparative study between effect of carbetocin and oxytocin on isoflurane-induced uterine hypotonia in twin pregnancy patients undergoing cesarean section, Egyptian Journal of Anaesthesia, 32 (1): 117–121, 2016</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="ch9.s1.ref3"><p id="p-122">
|
|
<strong>Gallos 2018</strong>
|
|
</p>Gallos, ID, Papadopoulou
|
|
A, Man
|
|
R, Athanasopoulos
|
|
N, Tobias
|
|
A, Price
|
|
MJ, Williams
|
|
MJ, Diaz
|
|
V, Pasquale
|
|
J, Chamillard
|
|
M, Widmer
|
|
M, Tunçalp
|
|
Ö, Hofmeyr
|
|
GJ, Althabe
|
|
F, Gülmezoglu
|
|
AM, Vogel
|
|
JP, Oladapo
|
|
OT, Coomarasamy
|
|
A. Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis, Cochrane Database of Systematic Reviews, 2018 [<a href="/pmc/articles/PMC6388086/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6388086</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30569545" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30569545</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="ch9.s1.ref4"><p id="p-123">
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<strong>Sotillo 2018</strong>
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</p>Sotillo, L., De la Calle, M., Magdaleno, F., Bartha, J. L., Efficacy of carbetocin for preventing postpartum bleeding after cesarean section in twin pregnancy, Journal of Maternal and Fetal Neonatal Medicine, 1–5, 2018 [<a href="https://pubmed.ncbi.nlm.nih.gov/30033782" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30033782</span></a>]</div></p></li></ul></div></div><div id="appendixesappgroup9"><h2 id="_appendixesappgroup9_">Appendices</h2><div id="ch9.appa"><h3>Appendix A. Review protocol</h3><div id="ch9.appa.s1"><h4>Review protocol – What is for the optimal method of managing the third stage of labour to reduce the risk of postpartum haemorrhage (PPH) in twin and triplet pregnancy?</h4><p id="ch9.appa.tab1"><a href="/books/NBK578069/table/ch9.appa.tab1/?report=objectonly" target="object" rid-ob="figobch9appatab1" class="figpopup">Table 3. Review protocol for managing the third stage of labour to reduce the risk of PPH</a></p></div></div><div id="ch9.appb"><h3>Appendix B. Literature search strategies</h3><p>Literature search for review question: What is for the optimal method of managing the third stage of labour to reduce the risk of postpartum haemorrhage (PPH) in twin and triplet pregnancy?</p><div id="ch9.appb.s1"><h4>Clinical Searches</h4><p>Date of initial search: 26/03/2018</p><p>Database(s): Embase Classic+Embase 1947 to 2018 March 23, Ovid MEDLINE(R) Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R) 1946 to Present</p><p>Date of updated search: 11/09/2018</p><p>Database(s): Embase Classic+Embase 1947 to 2018 September 11, Ovid MEDLINE(R) Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R) 1946 to Present</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch9appbtab1"><a href="/books/NBK578069/table/ch9.appb.tab1/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figch9appbtab1" rid-ob="figobch9appbtab1"><img class="small-thumb" src="/books/NBK578069/table/ch9.appb.tab1/?report=thumb" src-large="/books/NBK578069/table/ch9.appb.tab1/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="ch9.appb.tab1"><a href="/books/NBK578069/table/ch9.appb.tab1/?report=objectonly" target="object" rid-ob="figobch9appbtab1">Table</a></h4></div></div><p>Date of initial search: 26/03/2018</p><p>Database(s): The Cochrane Library, issue 3 of 12, March 2018</p><p>Date of updated search: 11/09/2018</p><p>Database(s): The Cochrane Library, issue 9 of 12, September 2018</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch9appbtab2"><a href="/books/NBK578069/table/ch9.appb.tab2/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figch9appbtab2" rid-ob="figobch9appbtab2"><img class="small-thumb" src="/books/NBK578069/table/ch9.appb.tab2/?report=thumb" src-large="/books/NBK578069/table/ch9.appb.tab2/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="ch9.appb.tab2"><a href="/books/NBK578069/table/ch9.appb.tab2/?report=objectonly" target="object" rid-ob="figobch9appbtab2">Table</a></h4></div></div></div><div id="ch9.appb.s2"><h4>Health economics searches</h4><p>For the Cochrane Library, see above</p><p>Date of initial search: 26/03/2018</p><p>Database(s): Embase Classic+Embase 1947 to 2018 March 23, Ovid MEDLINE(R) Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R) 1946 to Present</p><p>Date of updated search: 11/09/2018</p><p>Database(s): Embase Classic+Embase 1947 to 2018 September 11, Ovid MEDLINE(R) Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R) 1946 to Present</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch9appbtab3"><a href="/books/NBK578069/table/ch9.appb.tab3/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figch9appbtab3" rid-ob="figobch9appbtab3"><img class="small-thumb" src="/books/NBK578069/table/ch9.appb.tab3/?report=thumb" src-large="/books/NBK578069/table/ch9.appb.tab3/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="ch9.appb.tab3"><a href="/books/NBK578069/table/ch9.appb.tab3/?report=objectonly" target="object" rid-ob="figobch9appbtab3">Table</a></h4></div></div></div></div><div id="ch9.appc"><h3>Appendix C. Clinical evidence study selection</h3><p>Clinical evidence study selection for review question: What is for the optimal method of managing the third stage of labour to reduce the risk of postpartum haemorrhage (PPH) in twin and triplet pregnancy?</p><p id="ch9.appc.fig1"><a href="/books/NBK578069/figure/ch9.appc.fig1/?report=objectonly" target="object" rid-ob="figobch9appcfig1" class="figpopup">Figure 1. Flow diagram of clinical article selection for management of the third stage of labour to reduce PPH risk in twin and triplet pregnancy</a></p></div><div id="ch9.appd"><h3>Appendix D. Clinical evidence tables</h3><p>Clinical evidence tables for review question: What is for the optimal method of managing the third stage of labour to reduce the risk of postpartum haemorrhage (PPH) in twin and triplet pregnancy?</p><p id="ch9.appd.et1"><a href="/books/NBK578069/bin/ch9-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (430K)</span></p></div><div id="ch9.appe"><h3>Appendix E. Forest plots</h3><p>Forest plots for review question: What is for the optimal method of managing the third stage of labour to reduce the risk of postpartum haemorrhage (PPH) in twin and triplet pregnancy?</p><p>No meta-analysis was undertaken for this review and so there are no forest plots.</p></div><div id="ch9.appf"><h3>Appendix F. GRADE tables</h3><p>Grade profile for review question: What is for the optimal method of managing the third stage of labour to reduce the risk of postpartum haemorrhage (PPH) in twin and triplet pregnancy?</p><p id="ch9.appf.tab1"><a href="/books/NBK578069/table/ch9.appf.tab1/?report=objectonly" target="object" rid-ob="figobch9appftab1" class="figpopup">Table 4. Comparison: carbetocin versus oxytocin for active management of twin pregnancy in women undergoing caesarean section, outcomes for the woman</a></p></div><div id="ch9.appg"><h3>Appendix G. Economic evidence study selection</h3><p>Economic evidence study selection for review question: What is for the optimal method of managing the third stage of labour to reduce the risk of postpartum haemorrhage (PPH) in twin and triplet pregnancy?</p><p id="ch9.appg.fig1"><a href="/books/NBK578069/figure/ch9.appg.fig1/?report=objectonly" target="object" rid-ob="figobch9appgfig1" class="figpopup">Figure 2. Flow diagram of economic article selection for the optimal managing the third stage of labour to reduce the risk of postpartum haemorrhage (PPH) in twin and triplet pregnancy</a></p></div><div id="ch9.apph"><h3>Appendix H. Economic evidence tables</h3><p>Economic evidence tables for review question: What is for the optimal method of managing the third stage of labour to reduce the risk of postpartum haemorrhage (PPH) in twin and triplet pregnancy?</p><p>No economic evidence was identified for this review.</p></div><div id="ch9.appi"><h3>Appendix I. Economic evidence profiles</h3><p>Economic evidence profiles for review question: What is for the optimal method of managing the third stage of labour to reduce the risk of postpartum haemorrhage (PPH) in twin and triplet pregnancy?</p><p>No economic evidence was identified for this review.</p></div><div id="ch9.appj"><h3>Appendix J. Economic analysis</h3><p>Economic analysis for review question: What is for the optimal method of managing the third stage of labour to reduce the risk of postpartum haemorrhage (PPH) in twin and triplet pregnancy?</p><p>No economic analysis was identified for this review.</p></div><div id="ch9.appk"><h3>Appendix K. Excluded studies</h3><p>Excluded studies for review question: What is for the optimal method of managing the third stage of labour to reduce the risk of postpartum haemorrhage (PPH) in twin and triplet pregnancy?</p><div id="ch9.appk.s1"><h4>Clinical studies</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch9appktab1"><a href="/books/NBK578069/table/ch9.appk.tab1/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figch9appktab1" rid-ob="figobch9appktab1"><img class="small-thumb" src="/books/NBK578069/table/ch9.appk.tab1/?report=thumb" src-large="/books/NBK578069/table/ch9.appk.tab1/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="ch9.appk.tab1"><a href="/books/NBK578069/table/ch9.appk.tab1/?report=objectonly" target="object" rid-ob="figobch9appktab1">Table</a></h4></div></div></div><div id="ch9.appk.s2"><h4>Economic studies</h4><p>No health economic evidence was identified for this review.</p></div></div><div id="ch9.appl"><h3>Appendix L. Research recommendations</h3><p>Research recommendations for review question: What is for the optimal method of managing the third stage of labour to reduce the risk of postpartum haemorrhage (PPH) in twin and triplet pregnancy?</p><p>No research recommendation was made for this review.</p></div></div></div><div class="fm-sec"><div><p>Final</p></div><div><p>Evidence review</p><p>This evidence review was developed by the National Guideline Alliance which is a part of the Royal College of Obstetricians and Gynaecologists</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2019.</div><div class="small"><span class="label">Bookshelf ID: NBK578069</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/35192250" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">35192250</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobch9tab1"><div id="ch9.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">Summary of the protocol (PICO Table)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK578069/table/ch9.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.tab1_lrgtbl__"><table class="no_bottom_margin"><tbody><tr><th id="hd_b_ch9.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_ch9.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">All women confirmed as having a twin or triplet pregnancy by the 11–13-week ultrasound scan and carried to ≥24 weeks of pregnancy and all fetuses confirmed alive and who are in the third stage of labour. Setting: any setting</td></tr><tr><th id="hd_b_ch9.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><td headers="hd_b_ch9.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>Vaginal birth:</b>
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<ul id="ch9.l1"><li id="ch9.lt1" class="half_rhythm"><div>physiological management of the third stage of labour</div></li><li id="ch9.lt2" class="half_rhythm"><div>active management plus additional uterotonics, for example, further oxytocin (by infusion), longer-acting oxytocin, carboprost, misoprostol, ergometrine (as defined in studies)</div></li></ul>
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<p><b>Caesarean section:</b></p>
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<ul id="ch9.l2"><li id="ch9.lt3" class="half_rhythm"><div>active management plus additional uterotonics, for example, further oxytocin (by infusion), longer acting oxytocin, carboprost, misoprostol, ergometrine (as defined in studies)</div></li></ul></td></tr><tr><th id="hd_b_ch9.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison</th><td headers="hd_b_ch9.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>Vaginal birth:</b>
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<ul id="ch9.l3"><li id="ch9.lt4" class="half_rhythm"><div>active management of the third stage of labour:
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<ul id="ch9.l4" class="circle"><li id="ch9.lt5" class="half_rhythm"><div>administration of 10 IU of oxytocin by intramuscular injection with the birth of the anterior shoulder or immediately after the birth of the baby and before the cord is clamped and cut</div></li></ul></div></li></ul>
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<p><b>Caesarean section:</b></p>
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<ul id="ch9.l5"><li id="ch9.lt6" class="half_rhythm"><div>active management of the third stage of labour
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<ul id="ch9.l6" class="circle"><li id="ch9.lt7" class="half_rhythm"><div>administration of 10 IU of oxytocin by IV injection with the birth of the anterior shoulder or immediately after the birth of the baby and before the cord is clamped and cut</div></li></ul></div></li></ul></td></tr><tr><th id="hd_b_ch9.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_ch9.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>Critical</b>
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<p>For the woman:
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<ul id="ch9.l7"><li id="ch9.lt8" class="half_rhythm"><div>mortality</div></li><li id="ch9.lt9" class="half_rhythm"><div>PPH (blood loss > 1000ml)</div></li><li id="ch9.lt10" class="half_rhythm"><div>hysterectomy</div></li></ul>
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<b>Important:</b></p>
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<p>For the woman:
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<ul id="ch9.l8"><li id="ch9.lt11" class="half_rhythm"><div>side effects of drugs (for example, change in blood pressure, headache, nausea/vomiting)</div></li><li id="ch9.lt12" class="half_rhythm"><div>need for further intervention (for example, additional uterotonics, manual removal of placenta, blood transfusion, balloon tamponade)</div></li><li id="ch9.lt13" class="half_rhythm"><div>need for intensive care unit or high dependency unit</div></li><li id="ch9.lt14" class="half_rhythm"><div>women’s satisfaction/experience of labour and birth</div></li></ul></p>
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</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">IU: international unit; IV: intravenous; ml: millilitres; PPH: postpartum haemorrhage</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch9tab2"><div id="ch9.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of included studies for twin pregnancy</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK578069/table/ch9.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.tab2_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch9.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_ch9.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><th id="hd_h_ch9.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><th id="hd_h_ch9.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparator</th><th id="hd_h_ch9.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th></tr></thead><tbody><tr><td headers="hd_h_ch9.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#ch9.s1.ref1" rid="ch9.s1.ref1">Demetz 2013</a>
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</p>
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<p>Retrospective cohort</p>
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<p>France</p>
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</td><td headers="hd_h_ch9.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Women with twin or triplet pregnancy undergoing caesarean section (planned or emergency)</p>
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<ul id="ch9.l9"><li id="ch9.lt15" class="half_rhythm"><div>Before group (oxytocin): N=24 (0% triplets),</div></li><li id="ch9.lt16" class="half_rhythm"><div>After group (carbetocin) N=39(10.3% triplets) (<i>twins and triplets</i>)</div></li></ul></td><td headers="hd_h_ch9.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>“Active management”: Carbetocin: 100 microgram in IV injection</p>
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<ul id="ch9.l10"><li id="ch9.lt17" class="half_rhythm"><div>continued to receive oxytocin by slow perfusion 3 hours after birth</div></li></ul></td><td headers="hd_h_ch9.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">“Active management”:
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<ul id="ch9.l11"><li id="ch9.lt18" class="half_rhythm"><div>oxytocin as uterotonic</div></li><li id="ch9.lt19" class="half_rhythm"><div>10 units by IV injection</div></li></ul>
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</td><td headers="hd_h_ch9.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch9.l12"><li id="ch9.lt20" class="half_rhythm"><div>Blood loss (PPH)</div></li><li id="ch9.lt21" class="half_rhythm"><div>Blood transfusion</div></li><li id="ch9.lt22" class="half_rhythm"><div>Emergency surgery required</div></li></ul>
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</td></tr><tr><td headers="hd_h_ch9.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#ch9.s1.ref2" rid="ch9.s1.ref2">Fahmy 2016</a>
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</p>
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<p>RCT</p>
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<p>Egypt</p>
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</td><td headers="hd_h_ch9.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Women with twin pregnancy undergoing planned caesarean section</p>
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<ul id="ch9.l13"><li id="ch9.lt23" class="half_rhythm"><div>N=60 twin pregnancies:</div></li><li id="ch9.lt24" class="half_rhythm"><div>Control group (oxytocin): N=30</div></li><li id="ch9.lt25" class="half_rhythm"><div>Intervention (carbetocin): N=30</div></li></ul>
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</td><td headers="hd_h_ch9.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">“Active management”: Carbetocin: 100 microgram carbetocin in 10 ml saline solution was injected slowly IV over one minute after birth of babies</td><td headers="hd_h_ch9.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>“Active management”</p>
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<ul id="ch9.l14"><li id="ch9.lt26" class="half_rhythm"><div>oxytocin as uterotonic</div></li><li id="ch9.lt27" class="half_rhythm"><div>20 IU of oxytocin in 10 ml saline solution was injected slowly IV over one minute after birth of babies</div></li></ul>
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</td><td headers="hd_h_ch9.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch9.l15"><li id="ch9.lt28" class="half_rhythm"><div>Blood transfusion</div></li><li id="ch9.lt29" class="half_rhythm"><div>Side effect of the drugs - change in blood mean arterial blood pressure (measured in 5 minute intervals)</div></li><li id="ch9.lt30" class="half_rhythm"><div>Need for further intervention - additional uterotonics agents (methergine)</div></li></ul>
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</td></tr><tr><td headers="hd_h_ch9.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#ch9.s1.ref4" rid="ch9.s1.ref4">Sotillo 2018</a>
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</p>
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<p>Prospective cohort</p>
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<p>Spain</p>
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</td><td headers="hd_h_ch9.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Women with twin pregnancy undergoing caesarean section</p>
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<ul id="ch9.l16"><li id="ch9.lt31" class="half_rhythm"><div>N=166 twin pregnancies:</div></li><li id="ch9.lt32" class="half_rhythm"><div>Control group (oxytocin): N=80</div></li><li id="ch9.lt33" class="half_rhythm"><div>Intervention (carbetocin): N=86</div></li></ul></td><td headers="hd_h_ch9.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>“Active management”: Carbetocin</p>
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<ul id="ch9.l17"><li id="ch9.lt34" class="half_rhythm"><div>100 mg IV in bolus in the 1 minute after birth</div></li></ul>
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</td><td headers="hd_h_ch9.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>“Active management”</p>
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<ul id="ch9.l18"><li id="ch9.lt35" class="half_rhythm"><div>oxytocin as uterotonic</div></li><li id="ch9.lt36" class="half_rhythm"><div>20 IU of oxytocin in Ringer lactate 500 ml in 10–15 minutes</div></li></ul></td><td headers="hd_h_ch9.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch9.l19"><li id="ch9.lt37" class="half_rhythm"><div>Need for further treatment</div></li><li id="ch9.lt38" class="half_rhythm"><div>Need for additional uterotonics agents</div></li><li id="ch9.lt39" class="half_rhythm"><div>Blood transfusion</div></li></ul></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">IV: intravenous; min: minute; mg: milligrams; ml: millilitres; N: number of women; PPH: postpartum haemorrhage; RCT: randomised controlled trial</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch9appatab1"><div id="ch9.appa.tab1" class="table"><h3><span class="label">Table 3</span><span class="title">Review protocol for managing the third stage of labour to reduce the risk of PPH</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK578069/table/ch9.appa.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.appa.tab1_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">ID</th><th id="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Field (based on <a href="http://www.prisma-statement.org/Extensions/Protocols.aspx" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PRISMA-P</a>)</th><th id="hd_h_ch9.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Content</th></tr></thead><tbody><tr><td headers="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">I</td><td headers="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review question</td><td headers="hd_h_ch9.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">What is the optimal method of managing the third stage of labour to reduce the risk of postpartum haemorrhage (PPH) in twin and triplet pregnancy?</td></tr><tr><td headers="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">II</td><td headers="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Type of review question</td><td headers="hd_h_ch9.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</td></tr><tr><td headers="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">III</td><td headers="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Objective of the review</td><td headers="hd_h_ch9.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Twin and triplet pregnancy is associated with an increased risk of PPH. This review aims to address the uncertainty around the optimal management of the third stage of labour in twin and triplet pregnancy to prevent PPH</td></tr><tr><td headers="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">IV</td><td headers="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria - population/disease/condition/issue/domain</td><td headers="hd_h_ch9.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>All women confirmed as having a twin or triplet pregnancy by the 11–13-week ultrasound scan and carried to ≥24 weeks of pregnancy and all fetuses confirmed alive and who are in the third stage of labour</p>
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<p><b>Setting:</b> any setting</p>
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</td></tr><tr><td headers="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">V</td><td headers="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria - intervention(s)/exposure(s)/prognostic factor(s)</td><td headers="hd_h_ch9.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>Vaginal birth:</b>
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<ul id="ch9.l20"><li id="ch9.lt40" class="half_rhythm"><div>physiological management of third stage</div></li><li id="ch9.lt41" class="half_rhythm"><div>active management plus additional uterotonics, e.g. further oxytocin (by infusion), longer acting oxytocin, carboprost, misoprostol, ergometrine (as defined in studies)</div></li></ul>
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<p><b>Caesarean section:</b></p>
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<ul id="ch9.l21"><li id="ch9.lt42" class="half_rhythm"><div>active management plus additional uterotonics, e.g. further oxytocin (by infusion), longer acting oxytocin, carboprost, misoprostol, ergometrine (as defined in studies)</div></li></ul></td></tr><tr><td headers="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VI</td><td headers="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria - comparator(s)/control or reference (gold) standard</td><td headers="hd_h_ch9.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>Vaginal birth:</b>
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<ul id="ch9.l22"><li id="ch9.lt43" class="half_rhythm"><div>active management of third stage:
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<ul id="ch9.l23" class="circle"><li id="ch9.lt44" class="half_rhythm"><div>administration of 10 IU of oxytocin by intramuscular injection with the birth of the anterior shoulder or immediately after the birth of the baby and before the cord is clamped and cut</div></li></ul></div></li></ul>
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<p><b>Caesarean section:</b></p>
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<ul id="ch9.l24"><li id="ch9.lt45" class="half_rhythm"><div>active management of third stage:
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<ul id="ch9.l25" class="circle"><li id="ch9.lt46" class="half_rhythm"><div>administration of 10 IU of oxytocin by IV injection with the birth of the anterior shoulder or immediately after the birth of the baby and before the cord is clamped and cut</div></li></ul></div></li></ul>
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</td></tr><tr><td headers="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VII</td><td headers="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes and prioritisation</td><td headers="hd_h_ch9.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>Critical</b>
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<p>For the woman:
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<ul id="ch9.l26"><li id="ch9.lt47" class="half_rhythm"><div>mortality</div></li><li id="ch9.lt48" class="half_rhythm"><div>PPH (blood loss > 1000ml)</div></li><li id="ch9.lt49" class="half_rhythm"><div>hysterectomy</div></li></ul>
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<b>Important</b></p>
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<p>For the woman:
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<ul id="ch9.l27"><li id="ch9.lt50" class="half_rhythm"><div>side effects of drugs (e.g. change in blood pressure, headache, nausea/vomiting)</div></li><li id="ch9.lt51" class="half_rhythm"><div>need for further intervention (e.g. additional uterotonics, manual removal of placenta, blood transfusion, balloon tamponade)</div></li><li id="ch9.lt52" class="half_rhythm"><div>need for intensive care unit or high dependency unit</div></li><li id="ch9.lt53" class="half_rhythm"><div>women’s satisfaction/experience of labour and birth</div></li></ul></p>
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</td></tr><tr><td headers="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VIII</td><td headers="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria - study design</td><td headers="hd_h_ch9.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Systematic reviews of randomised controlled trials (RCTs) for twin and triplet pregnancy</p>
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<p>Randomised controlled trials</p>
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<p>If insufficient trial evidence is available for each comparison:</p>
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<p>Cohort studies for triplets (prospective cohort studies will be prioritised over retrospective)</p>
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<p>Conference abstracts will not be considered</p>
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</td></tr><tr><td headers="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">IX</td><td headers="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other inclusion exclusion criteria</td><td headers="hd_h_ch9.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Exclusions:
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<ul id="ch9.l28"><li id="ch9.lt54" class="half_rhythm"><div>women with a quadruplet or higher-order pregnancy as per scope</div></li><li id="ch9.lt55" class="half_rhythm"><div>women with known serious fetal anomaly</div></li><li id="ch9.lt56" class="half_rhythm"><div>studies that do not report results specifically for twin and/or triplet pregnancies</div></li><li id="ch9.lt57" class="half_rhythm"><div>studies that include <5 pregnancies</div></li><li id="ch9.lt58" class="half_rhythm"><div>women with placenta praevia or morbidly adherent placenta (accreta, increta, percreta)</div></li><li id="ch9.lt59" class="half_rhythm"><div>women with medical bleeding disorders</div></li><li id="ch9.lt60" class="half_rhythm"><div>women with fibroids</div></li></ul>
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</td></tr><tr><td headers="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">X</td><td headers="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Proposed sensitivity/sub-group analysis, or meta-regression</td><td headers="hd_h_ch9.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Special consideration will be given to the following groups for which data will be reviewed and analysed separately if available:
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<ul id="ch9.l29"><li id="ch9.lt61" class="half_rhythm"><div>Twin pregnancy</div></li><li id="ch9.lt62" class="half_rhythm"><div>Triplet pregnancy</div></li><li id="ch9.lt63" class="half_rhythm"><div>Vaginal birth</div></li><li id="ch9.lt64" class="half_rhythm"><div>Caesarean section</div></li></ul>
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The following groups will used to explore any significant heterogeneity identified:
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<ul id="ch9.l30"><li id="ch9.lt65" class="half_rhythm"><div>parity</div></li><li id="ch9.lt66" class="half_rhythm"><div>previous caesarean section</div></li><li id="ch9.lt67" class="half_rhythm"><div>previous PPH</div></li></ul>
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</td></tr><tr><td headers="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XI</td><td headers="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Selection process - duplicate screening/selection/analysis</td><td headers="hd_h_ch9.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Formal duplicate screening will not be undertaken for this question (as it has not been prioritised for economic analysis), although there will be senior supervision of the selection process. Hard copies of retrieved papers will be read by two reviewers and any disputes will be resolved in discussion with the Topic Advisor. Data extraction will be supervised by a senior reviewer. Draft excluded studies and evidence tables will be discussed with the Topic Advisor, prior to circulation to the Topic Group for their comments. Resolution of disputes will be by discussion between the senior reviewer, Topic Advisor and Chair</td></tr><tr><td headers="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XII</td><td headers="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data management (software)</td><td headers="hd_h_ch9.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>NGA STAR software will be used for generating bibliographies/citations, study sifting, data extraction and recording quality assessment using checklists.</p>
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<p>Pairwise meta-analyses, if possible, will be performed using Cochrane Review Manager (RevMan5).</p>
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<p>‘GRADEpro’ will be used to assess the quality of evidence for each outcome. A full description of this is provided in the methods in supplementary material C.</p></td></tr><tr><td headers="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XIII</td><td headers="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Information sources - databases and dates</td><td headers="hd_h_ch9.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Sources to be searched: Medline, Medline In-Process, CCTR, CDSR, DARE, HTA, Embase.</p>
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<p>Search limits:
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<ul id="ch9.l31"><li id="ch9.lt68" class="half_rhythm"><div>Limit to English language</div></li><li id="ch9.lt69" class="half_rhythm"><div>Limit to human-only studies</div></li></ul>
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No limit on study design</p>
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<p>No limit year of publication</p>
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<p>Limit to randomised controlled trials (RCTs) and systematic reviews in first instance but download all results.</p>
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</td></tr><tr><td headers="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XIV</td><td headers="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Identify if an update</td><td headers="hd_h_ch9.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">This is a new area in the guideline.</td></tr><tr><td headers="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XV</td><td headers="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Author contacts</td><td headers="hd_h_ch9.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Developer: National Guideline Alliance <a href="https://www.nice.org.uk/guidance/indevelopment/gid-ng10063" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.nice.org<wbr style="display:inline-block"></wbr>​.uk/guidance/indevelopment/gid-ng10063</a></td></tr><tr><td headers="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XVI</td><td headers="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Highlight if amendment to previous protocol</td><td headers="hd_h_ch9.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>For details please see section 4.5 of <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overviewing-the-quality-of-the-evidence" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual 2014</a></p>
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<p>For details please see <a href="#ch9.appb">appendix B</a>.</p></td></tr><tr><td headers="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XVII</td><td headers="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Search strategy - for one database</td><td headers="hd_h_ch9.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see <a href="#ch9.appb">appendix B</a>.</td></tr><tr><td headers="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XVIII</td><td headers="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data collection process - forms/duplicate</td><td headers="hd_h_ch9.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A standardised evidence table format will be used, and published as <a href="#ch9.appd">appendix D</a> (clinical evidence tables) or <a href="#ch9.apph">H</a> (economic evidence tables)</td></tr><tr><td headers="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XIX</td><td headers="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data items - define all variables to be collected</td><td headers="hd_h_ch9.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see evidence tables in <a href="#ch9.appd">appendix D</a> (clinical evidence tables) or <a href="#ch9.apph">H</a> (economic evidence tables)</td></tr><tr><td headers="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XX</td><td headers="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Methods for assessing bias at outcome/study level</td><td headers="hd_h_ch9.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Quality assessment of individual studies will be performed using the following checklists:
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<ul id="ch9.l32"><li id="ch9.lt70" class="half_rhythm"><div>AMSTAR for systematic reviews,</div></li><li id="ch9.lt71" class="half_rhythm"><div>Cochrane risk of bias for RCTs</div></li><li id="ch9.lt72" class="half_rhythm"><div>Newcastle-Ottawa scale for cohort studies</div></li></ul>
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For details please see section 6.2 of <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overviewing-the-quality-of-the-evidence" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual 2014</a></p>
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<p>The risk of bias across all available evidence was evaluated for each outcome using an adaptation of the ‘Grading of Recommendations Assessment, Development and Evaluation (GRADE) toolbox’ developed by the international GRADE working group <a href="http://www.gradeworkinggroup.org/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.gradeworkinggroup.org/</a></p></td></tr><tr><td headers="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XXI</td><td headers="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Criteria for quantitative synthesis (where suitable)</td><td headers="hd_h_ch9.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see section 6.4 of <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overviewing-the-quality-of-the-evidence" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual 2014</a></td></tr><tr><td headers="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XXII</td><td headers="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Methods for analysis - combining studies and exploring (in)consistency</td><td headers="hd_h_ch9.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A full description of this is provided in the methods in supplementary material C.</td></tr><tr><td headers="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XXIII</td><td headers="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meta-bias assessment - publication bias, selective reporting bias</td><td headers="hd_h_ch9.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see section 6.2 of <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overviewing-the-quality-of-the-evidence" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual 2014</a></td></tr><tr><td headers="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XXIV</td><td headers="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Assessment of confidence in cumulative evidence</td><td headers="hd_h_ch9.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see sections 6.4 and 9.1 of <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overviewing-the-quality-of-the-evidence" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual 2014</a></td></tr><tr><td headers="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XXV</td><td headers="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rationale/context - Current management</td><td headers="hd_h_ch9.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see the introduction to the evidence review</td></tr><tr><td headers="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XXVI</td><td headers="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Describe contributions of authors and guarantor</td><td headers="hd_h_ch9.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>A multidisciplinary committee developed the guideline. The committee was convened by the National Guideline Alliance and chaired by Anthony Pearson in line with section 3 of <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overviewing-the-quality-of-the-evidence" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual 2014</a></p>
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<p>Staff from the National Guideline Alliance undertook systematic literature searches, appraised the evidence, conducted meta-analysis and cost-effectiveness analysis where appropriate, and drafted the guideline in collaboration with the committee. A full description of this is provided in the methods in supplementary material C.</p></td></tr><tr><td headers="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XXVII</td><td headers="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sources of funding/support</td><td headers="hd_h_ch9.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The National Guideline Alliance is funded by NICE and hosted by the Royal College of Obstetricians and Gynaecologists.</td></tr><tr><td headers="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XXVIII</td><td headers="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Name of sponsor</td><td headers="hd_h_ch9.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The National Guideline Alliance is funded by NICE and hosted by the Royal College of Obstetricians and Gynaecologists.</td></tr><tr><td headers="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XXIX</td><td headers="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Roles of sponsor</td><td headers="hd_h_ch9.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NICE funds the National Guideline Alliance to develop guidelines for those working in the NHS, public health, and social care in England.</td></tr><tr><td headers="hd_h_ch9.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">XXX</td><td headers="hd_h_ch9.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PROSPERO registration number</td><td headers="hd_h_ch9.appa.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not registered with PROSPERO</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">AMSTAR: Assessing the Methodological Quality of Systematic Reviews; CCTR: Cochrane Central 1 Register for Controlled Trials; CDSR: Cochrane Database of Systematic Reviews; DARE: Database of 2 Abstracts of Reviews of Effects; HTA: Health Technology Assessment; GRADE: Grading of 3 Recommendations Assessment, Development and Evaluation; IU: international unit; IV: intravenous; 4 NGA: National Guideline Alliance; NICE: National Institute for Health and Care Excellence</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch9appbtab1"><div id="ch9.appb.tab1" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK578069/table/ch9.appb.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.appb.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#</th><th id="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Searches</th></tr></thead><tbody><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Pregnancy, Multiple/ use ppez</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp multiple pregnancy/ use emczd</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((dizygotic or monozygotic or multiple or triplet* or trizygotic or twin) adj3 (birth* or f?etus* or f?etal or gestation* or pregnan*)).tw.</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(chorionicity or dichorionic or monochorionic or trichorionic).tw.</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1–4</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((active management or expectant management or physiological management or natural) adj3 (“3rd stage” or “stage 3” or third stage)).tw.</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(EMTSLorAMTSL).tw.</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((placenta* or afterbirth) adj3 (separat* or expulsion or expel* or extract* or remov* or push* or pull* or maternal effort)).tw.</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Oxytocics/ use ppez or Oxytocin/ use ppez or oxytocic agent/ use emczd</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Uterotonic agent/ use emczd</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp ergot alkaloids/ppez or ergonovine/ use ppez or ergot alkaloid/ use emczd</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Misoprostol/ use ppez or Carboprost/ use ppez or carboprost/ use emczd or misoprostol/ use emczd</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(carboprost* or ergometrin* or ergonovin* or ergot alkaloid* or misoprostol* or oxytoci* or uterotonic*).tw.</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cord clamping or cord-clamping or cordclamping or cord traction or cord cutting).tw.</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Postpartum Hemorrhage/pc use ppez or postpartum hemorrhage/pc use emczd</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((postpartu* or post partu* or excessive or high or severe) adj3 (blood* or bleed* or haemorrhag* or hemorrhag*) adj3 prevent*).tw.</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/6–16</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5 and 17</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Letter/ use ppez</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter.pt. or letter/ use emczd</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">note.pt.</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial.pt.</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Editorial/ use ppez</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">News/ use ppez</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Historical Article/ use ppez</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anecdotes as Topic/ use ppez</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comment/ use ppez</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Case Report/ use ppez</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/ or case study/ use emczd</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/19–30</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ use ppez</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ use emczd</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">random*.ti,ab.</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/32–34</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31 not 35</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animals/ not humans/ use ppez</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal/ not human/ use emczd</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">nonhuman/ use emczd</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animals, Laboratory/ use ppez</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experimentation/ use ppez</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experiment/ use emczd</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Experimental Animal/ use emczd</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Models, Animal/ use ppez</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal model/ use emczd</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodentia/ use ppez</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodent/ use emczd</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/36–48</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18 not 49</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 50 to english language</td></tr><tr><td headers="hd_h_ch9.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52</td><td headers="hd_h_ch9.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">remove duplicates from 51</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch9appbtab2"><div id="ch9.appb.tab2" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK578069/table/ch9.appb.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.appb.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_ch9.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ID</th><th id="hd_h_ch9.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Searches</th></tr></thead><tbody><tr><td headers="hd_h_ch9.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1</td><td headers="hd_h_ch9.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Pregnancy, Multiple] explode all trees</td></tr><tr><td headers="hd_h_ch9.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#2</td><td headers="hd_h_ch9.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((dizygotic or monozygotic or multiple or triplet* or trizygotic or twin) near/3 (birth* or foetus* or foetal or fetus* or fetal or gestation* or pregnan*))</td></tr><tr><td headers="hd_h_ch9.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#3</td><td headers="hd_h_ch9.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(monochorionic* or dichorionic* or trichorionic*)</td></tr><tr><td headers="hd_h_ch9.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#4</td><td headers="hd_h_ch9.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">{or #1–#3}</td></tr><tr><td headers="hd_h_ch9.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#5</td><td headers="hd_h_ch9.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((active management or expectant management or physiological management or natural) near/3 (“3rd stage” or “stage 3” or third stage))</td></tr><tr><td headers="hd_h_ch9.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#6</td><td headers="hd_h_ch9.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(EMTSL or AMTSL)</td></tr><tr><td headers="hd_h_ch9.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#7</td><td headers="hd_h_ch9.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((placenta* or afterbirth) near/3 (separat* or expulsion or expel* or extract* or push* or pull* or remov* or maternal effort))</td></tr><tr><td headers="hd_h_ch9.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#8</td><td headers="hd_h_ch9.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Oxytocics] this term only</td></tr><tr><td headers="hd_h_ch9.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#9</td><td headers="hd_h_ch9.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Oxytocin] this term only</td></tr><tr><td headers="hd_h_ch9.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#10</td><td headers="hd_h_ch9.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Ergot Alkaloids] explode all trees</td></tr><tr><td headers="hd_h_ch9.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#11</td><td headers="hd_h_ch9.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Misoprostol] this term only</td></tr><tr><td headers="hd_h_ch9.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#12</td><td headers="hd_h_ch9.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Carboprost] this term only</td></tr><tr><td headers="hd_h_ch9.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#13</td><td headers="hd_h_ch9.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(carboprost* or ergometrine* or ergonovine* or ergot alkaloids or misoprostol* or oxytoci* or uterotonic*)</td></tr><tr><td headers="hd_h_ch9.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#14</td><td headers="hd_h_ch9.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cord clamping or cord-clamping or cordclamping or cord traction or cord cutting) .tw.</td></tr><tr><td headers="hd_h_ch9.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#15</td><td headers="hd_h_ch9.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Postpartum Hemorrhage] this term only and with qualifier(s): [Prevention & control - PC]</td></tr><tr><td headers="hd_h_ch9.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#16</td><td headers="hd_h_ch9.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((postpartu* or post partu* or excessive or high or severe) near/3 (blood* or bleed* or haemorrhag* or hemorrhag*) near/3 prevent*)</td></tr><tr><td headers="hd_h_ch9.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#17</td><td headers="hd_h_ch9.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">{or #5–#16}</td></tr><tr><td headers="hd_h_ch9.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#18</td><td headers="hd_h_ch9.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#4 and #17</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch9appbtab3"><div id="ch9.appb.tab3" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK578069/table/ch9.appb.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.appb.tab3_lrgtbl__"><table><thead><tr><th id="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></th><th id="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Searches</th></tr></thead><tbody><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Pregnancy, Multiple/ use ppez</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp multiple pregnancy/ use emczd</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((dizygotic or monozygotic or multiple or triplet* or trizygotic or twin) adj3 (birth* or f?etus* or f?etal or gestation* or pregnan*)).tw.</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(chorionicity or dichorionic or monochorionic or trichorionic).tw.</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1–4</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((active management or expectant management or physiological management or natural) adj3 (“3rd stage” or “stage 3” or third stage)).tw.</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(EMTSL or AMTSL).tw.</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((placenta* or afterbirth) adj3 (separat* or expulsion or expel* or extract* or remov* or push* or pull* or maternal effort)).tw.</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Oxytocics/ use ppez or Oxytocin/ use ppez or oxytocic agent/ use emczd</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Uterotonic agent/ use emczd</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp ergot alkaloids/ppez or ergonovine/ use ppez or ergot alkaloid/ use emczd</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Misoprostol/ use ppez or Carboprost/ use ppez or carboprost/ use emczd or misoprostol/ use emczd</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(carboprost* or ergometrin* or ergonovin* or ergot alkaloid* or misoprostol* or oxytoci* or uterotonic*).tw.</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cord clamping or cord-clamping or cordclamping or cord traction or cord cutting).tw.</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Postpartum Hemorrhage/pc use ppez or postpartum hemorrhage/pc use emczd</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((postpartu* or post partu* or excessive or high or severe) adj3 (blood* or bleed* or haemorrhag* or hemorrhag*) adj3 prevent*).tw.</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/6–16</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5 and 17</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Letter/ use ppez</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter.pt. or letter/ use emczd</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">note.pt.</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial.pt.</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Editorial/ use ppez</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">News/ use ppez</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Historical Article/ use ppez</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anecdotes as Topic/ use ppez</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comment/ use ppez</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Case Report/ use ppez</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/ or case study/ use emczd</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/19–30</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ use ppez</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ use emczd</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">random*.ti,ab.</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/32–34</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31 not 35</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animals/ not humans/ use ppez</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal/ not human/ use emczd</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">nonhuman/ use emczd</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animals, Laboratory/ use ppez</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experimentation/ use ppez</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experiment/ use emczd</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Experimental Animal/ use emczd</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Models, Animal/ use ppez</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal model/ use emczd</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodentia/ use ppez</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodent/ use emczd</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/36–48</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18 not 49</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 50 to english language</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics/</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Value of life/</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp “Costs and Cost Analysis”/</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Economics, Hospital/</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">56</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Economics, Medical/</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">57</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics, Nursing/</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">58</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics, Pharmaceutical/</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">59</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp “Fees and Charges”/</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">60</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Budgets/</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">61</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(or/52–60) use ppez</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">62</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">health economics/</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">63</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp economic evaluation/</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">64</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp health care cost/</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">65</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp fee/</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">66</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget/</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">67</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">funding/</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">68</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(or/62–67) use emczd</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">69</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget*.ti,ab.</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">70</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cost*.ti.</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">71</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(economic* or pharmaco?economic*).ti.</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">72</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(price* or pricing*).ti,ab.</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">73</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cost* adj2 (effective* or utilit* or benefit* or minimi* or unit* or estimat* or variable*)).ab.</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">74</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(financ* or fee or fees).ti,ab.</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">75</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(value adj2 (money or monetary)).ti,ab.</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">76</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/69–74</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">77</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">61 or 68 or 76</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">78</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51 and 77</td></tr><tr><td headers="hd_h_ch9.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">79</td><td headers="hd_h_ch9.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">remove duplicates from 78</td></tr></tbody></table></div></div></article><article data-type="fig" id="figobch9appcfig1"><div id="ch9.appc.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%201.%20Flow%20diagram%20of%20clinical%20article%20selection%20for%20management%20of%20the%20third%20stage%20of%20labour%20to%20reduce%20PPH%20risk%20in%20twin%20and%20triplet%20pregnancy.&p=BOOKS&id=578069_ch9appcf1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK578069/bin/ch9appcf1.jpg" alt="Figure 1. Flow diagram of clinical article selection for management of the third stage of labour to reduce PPH risk in twin and triplet pregnancy." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 1</span><span class="title">Flow diagram of clinical article selection for management of the third stage of labour to reduce PPH risk in twin and triplet pregnancy</span></h3></div></article><article data-type="table-wrap" id="figobch9appftab1"><div id="ch9.appf.tab1" class="table"><h3><span class="label">Table 4</span><span class="title">Comparison: carbetocin versus oxytocin for active management of twin pregnancy in women undergoing caesarean section, outcomes for the woman</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK578069/table/ch9.appf.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.appf.tab1_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch9.appf.tab1_1_1_1_1" colspan="7" rowspan="1" style="text-align:left;vertical-align:bottom;">Quality assessment</th><th id="hd_h_ch9.appf.tab1_1_1_1_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Number of women</th><th id="hd_h_ch9.appf.tab1_1_1_1_3" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Effect</th><th id="hd_h_ch9.appf.tab1_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_ch9.appf.tab1_1_1_1_4" style="text-align:left;vertical-align:bottom;">Quality</th><th id="hd_h_ch9.appf.tab1_1_1_1_5" rowspan="2" colspan="1" headers="hd_h_ch9.appf.tab1_1_1_1_5" style="text-align:left;vertical-align:bottom;">Importance</th></tr><tr><th headers="hd_h_ch9.appf.tab1_1_1_1_1" id="hd_h_ch9.appf.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Number of studies</th><th headers="hd_h_ch9.appf.tab1_1_1_1_1" id="hd_h_ch9.appf.tab1_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Design</th><th headers="hd_h_ch9.appf.tab1_1_1_1_1" id="hd_h_ch9.appf.tab1_1_1_2_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk of bias</th><th headers="hd_h_ch9.appf.tab1_1_1_1_1" id="hd_h_ch9.appf.tab1_1_1_2_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Inconsistency</th><th headers="hd_h_ch9.appf.tab1_1_1_1_1" id="hd_h_ch9.appf.tab1_1_1_2_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Indirectness</th><th headers="hd_h_ch9.appf.tab1_1_1_1_1" id="hd_h_ch9.appf.tab1_1_1_2_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Imprecision</th><th headers="hd_h_ch9.appf.tab1_1_1_1_1" id="hd_h_ch9.appf.tab1_1_1_2_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Other considerations</th><th headers="hd_h_ch9.appf.tab1_1_1_1_2" id="hd_h_ch9.appf.tab1_1_1_2_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">CAR (IG)</th><th headers="hd_h_ch9.appf.tab1_1_1_1_2" id="hd_h_ch9.appf.tab1_1_1_2_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">OXY (CG)</th><th headers="hd_h_ch9.appf.tab1_1_1_1_3" id="hd_h_ch9.appf.tab1_1_1_2_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Relative (95% Cl)</th><th headers="hd_h_ch9.appf.tab1_1_1_1_3" id="hd_h_ch9.appf.tab1_1_1_2_11" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Absolute</th></tr></thead><tbody><tr><th headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_h_ch9.appf.tab1_1_1_2_3 hd_h_ch9.appf.tab1_1_1_2_4 hd_h_ch9.appf.tab1_1_1_2_5 hd_h_ch9.appf.tab1_1_1_2_6 hd_h_ch9.appf.tab1_1_1_2_7 hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_h_ch9.appf.tab1_1_1_2_9 hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_h_ch9.appf.tab1_1_1_2_11 hd_h_ch9.appf.tab1_1_1_1_4 hd_h_ch9.appf.tab1_1_1_1_5" id="hd_b_ch9.appf.tab1_1_1_1_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Postpartum haemorrhage (blood loss, ml)</th></tr><tr><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_b_ch9.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_b_ch9.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Observational studies</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_3 hd_b_ch9.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious risk of bias</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_4 hd_b_ch9.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious inconsistency</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_5 hd_b_ch9.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>1</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_6 hd_b_ch9.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>2</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_7 hd_b_ch9.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_b_ch9.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_9 hd_b_ch9.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_b_ch9.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_11 hd_b_ch9.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MD 140 less (484 less to 204 more)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_4 hd_b_ch9.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW ⊕⊖⊖⊖</td><td headers="hd_h_ch9.appf.tab1_1_1_1_5 hd_b_ch9.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_h_ch9.appf.tab1_1_1_2_3 hd_h_ch9.appf.tab1_1_1_2_4 hd_h_ch9.appf.tab1_1_1_2_5 hd_h_ch9.appf.tab1_1_1_2_6 hd_h_ch9.appf.tab1_1_1_2_7 hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_h_ch9.appf.tab1_1_1_2_9 hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_h_ch9.appf.tab1_1_1_2_11 hd_h_ch9.appf.tab1_1_1_1_4 hd_h_ch9.appf.tab1_1_1_1_5" id="hd_b_ch9.appf.tab1_1_1_3_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Side effects of drugs - change in mean arterial blood pressure over time (fall in BP is not beneficial: stable or higher BP is preferable to lower BP)</th></tr><tr><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>1</p>
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<p>Baseline (0 mins)</p></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_3 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious risk of bias</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_4 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious inconsistency</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_5 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious indirectness</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_6 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>2</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_7 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_9 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_11 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MD 1.10 lower (3.93 lower to 1.73 higher)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_4 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">⊕⊕⊕⊖ MODERATE</td><td headers="hd_h_ch9.appf.tab1_1_1_1_5 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">IMPORTANT</td></tr><tr><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>1</p>
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<p>(5 mins)</p></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_3 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious risk of bias</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_4 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious inconsistency</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_5 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious indirectness</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_6 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>2</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_7 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_9 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_11 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MD 0.40 lower (2.17 lower to 1.37 higher)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_4 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">⊕⊕⊕⊖ MODERATE</td><td headers="hd_h_ch9.appf.tab1_1_1_1_5 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">IMPORTANT</td></tr><tr><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>1</p>
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<p>(10 mins)</p></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_3 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious risk of bias</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_4 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious inconsistency</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_5 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious indirectness</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_6 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>3</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_7 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_9 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_11 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MD 1.50 higher (0.23 lower to 3.23 higher)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_4 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">⊕⊕⊕⊖ MODERATE</td><td headers="hd_h_ch9.appf.tab1_1_1_1_5 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">IMPORTANT</td></tr><tr><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>1</p>
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<p>(15 mins)</p></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_3 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious risk of bias</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_4 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious inconsistency</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_5 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious indirectness</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_6 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious imprecision</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_7 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_9 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_11 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MD 4.20 higher (2.90 to 5.50 higher)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_4 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">⊕⊕⊕⊕ HIGH</td><td headers="hd_h_ch9.appf.tab1_1_1_1_5 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">IMPORTANT</td></tr><tr><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>1</p>
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<p>(20 mins)</p></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_3 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious risk of bias</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_4 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious inconsistency</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_5 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious indirectness</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_6 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious imprecision</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_7 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_9 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_11 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MD 5.00 higher (3.35 to 6.65 higher)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_4 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">⊕⊕⊕⊕ HIGH</td><td headers="hd_h_ch9.appf.tab1_1_1_1_5 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">IMPORTANT</td></tr><tr><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>1</p>
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<p>(25 mins)</p></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_3 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious risk of bias</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_4 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious inconsistency</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_5 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious indirectness</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_6 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious imprecision</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_7 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_9 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_11 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MD 5.30 higher (3.93 to 6.67 higher)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_4 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">⊕⊕⊕⊕ HIGH</td><td headers="hd_h_ch9.appf.tab1_1_1_1_5 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">IMPORTANT</td></tr><tr><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>1</p>
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<p>(30 mins)</p></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_3 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious risk of bias</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_4 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious inconsistency</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_5 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious indirectness</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_6 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious imprecision</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_7 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_9 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_11 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MD 4.8 higher (3.61 to 5.99 higher)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_4 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">⊕⊕⊕⊕ HIGH</td><td headers="hd_h_ch9.appf.tab1_1_1_1_5 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">IMPORTANT</td></tr><tr><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>1</p>
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<p>(35 mins)</p></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_3 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious risk of bias</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_4 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious inconsistency</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_5 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious indirectness</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_6 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>3</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_7 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_9 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_11 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MD 3.60 higher (1.62 to 5.58 higher)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_4 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">⊕⊕⊕⊖ MODERATE</td><td headers="hd_h_ch9.appf.tab1_1_1_1_5 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">IMPORTANT</td></tr><tr><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>1</p>
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<p>(40 mins)</p></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_3 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious risk of bias</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_4 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious inconsistency</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_5 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious indirectness</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_6 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious imprecision</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_7 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_9 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_11 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MD 4.70 higher (2.87 to 6.53 higher)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_4 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">⊕⊕⊕⊕ HIGH</td><td headers="hd_h_ch9.appf.tab1_1_1_1_5 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">IMPORTANT</td></tr><tr><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>1</p>
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<p>(50 mins)</p></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_3 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious risk of bias</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_4 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious inconsistency</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_5 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious indirectness</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_6 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious imprecision</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_7 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_9 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_11 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MD 4.50 higher (2.36 to 6.64 higher)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_4 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">⊕⊕⊕⊕ HIGH</td><td headers="hd_h_ch9.appf.tab1_1_1_1_5 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">IMPORTANT</td></tr><tr><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>1</p>
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<p>(60 mins)</p></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_3 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious risk of bias</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_4 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious inconsistency</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_5 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious indirectness</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_6 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious imprecision</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_7 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_9 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_11 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MD 3.80 higher (1.85 to 5.75 higher)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_4 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">⊕⊕⊕⊕ HIGH</td><td headers="hd_h_ch9.appf.tab1_1_1_1_5 hd_b_ch9.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">IMPORTANT</td></tr><tr><th headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_h_ch9.appf.tab1_1_1_2_3 hd_h_ch9.appf.tab1_1_1_2_4 hd_h_ch9.appf.tab1_1_1_2_5 hd_h_ch9.appf.tab1_1_1_2_6 hd_h_ch9.appf.tab1_1_1_2_7 hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_h_ch9.appf.tab1_1_1_2_9 hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_h_ch9.appf.tab1_1_1_2_11 hd_h_ch9.appf.tab1_1_1_1_4 hd_h_ch9.appf.tab1_1_1_1_5" id="hd_b_ch9.appf.tab1_1_1_15_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Need for further treatment (any: anaemia treatment and/or additional uterotonic agents)</th></tr><tr><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_b_ch9.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_b_ch9.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Observational studies</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_3 hd_b_ch9.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious risk of bias</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_4 hd_b_ch9.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious inconsistency</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_5 hd_b_ch9.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious indirectness</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_6 hd_b_ch9.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious imprecision<sup>4</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_7 hd_b_ch9.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_b_ch9.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6/86 (7%)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_9 hd_b_ch9.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17/80 (21.3%)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_b_ch9.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.33 (0.14 to 0.79)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_11 hd_b_ch9.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">142 fewer per 1000 (from 45 fewer to 183 fewer)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_4 hd_b_ch9.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">⊕⊕⊖⊖ LOW</td><td headers="hd_h_ch9.appf.tab1_1_1_1_5 hd_b_ch9.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">IMPORTANT</td></tr><tr><th headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_h_ch9.appf.tab1_1_1_2_3 hd_h_ch9.appf.tab1_1_1_2_4 hd_h_ch9.appf.tab1_1_1_2_5 hd_h_ch9.appf.tab1_1_1_2_6 hd_h_ch9.appf.tab1_1_1_2_7 hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_h_ch9.appf.tab1_1_1_2_9 hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_h_ch9.appf.tab1_1_1_2_11 hd_h_ch9.appf.tab1_1_1_1_4 hd_h_ch9.appf.tab1_1_1_1_5" id="hd_b_ch9.appf.tab1_1_1_17_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Need for additional uterotonic agents</th></tr><tr><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Observational studies</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_3 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious risk of bias</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_4 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious inconsistency</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_5 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious indirectness</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_6 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>4</sup><sup>,</sup>
|
|
<sup>5</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_7 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3/86 (3.5%)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_9 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7/80 (8.8%)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.4 (0.11 to 1.49)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_11 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52 fewer per 1000 (from 78 fewer to 43 more)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_4 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">⊕⊖⊖⊖ VERY LOW</td><td headers="hd_h_ch9.appf.tab1_1_1_1_5 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">IMPORTANT</td></tr><tr><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_3 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious risk of bias</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_4 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious inconsistency</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_5 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious indirectness</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_6 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious imprecision</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_7 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4/30 (13.3%)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_9 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15/30 (50%)<sup>6</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.27 (0.10 to 0.71)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_11 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">365 fewer per 1000 (from 145 fewer to 450 fewer)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_4 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">⊕⊕⊕⊕ HIGH</td><td headers="hd_h_ch9.appf.tab1_1_1_1_5 hd_b_ch9.appf.tab1_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">IMPORTANT</td></tr><tr><th headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_h_ch9.appf.tab1_1_1_2_3 hd_h_ch9.appf.tab1_1_1_2_4 hd_h_ch9.appf.tab1_1_1_2_5 hd_h_ch9.appf.tab1_1_1_2_6 hd_h_ch9.appf.tab1_1_1_2_7 hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_h_ch9.appf.tab1_1_1_2_9 hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_h_ch9.appf.tab1_1_1_2_11 hd_h_ch9.appf.tab1_1_1_1_4 hd_h_ch9.appf.tab1_1_1_1_5" id="hd_b_ch9.appf.tab1_1_1_20_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Blood transfusion</th></tr><tr><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Observational studies</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_3 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious risk of bias<sup>4</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_4 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious inconsistency</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_5 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious indirectness</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_6 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>7</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_7 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1/86 (1.2%)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_9 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8/80 (10%)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.12 (0.01 to 0.91)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_11 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">88 fewer per 1000 (from 9 fewer to 99 fewer)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_4 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">⊕⊖⊖⊖ VERY LOW</td><td headers="hd_h_ch9.appf.tab1_1_1_1_5 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">IMPORTANT</td></tr><tr><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Observational studies</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_3 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious risk of bias</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_4 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious inconsistency</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_5 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>1</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_6 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>5</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_7 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2/39 (5.1%)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_9 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1/24 (4.2%)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 1.23 (0.12 to 12.85)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_11 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 more per 1000(37 fewer to 494 more)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_4 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">⊕⊖⊖⊖ VERY LOW</td><td headers="hd_h_ch9.appf.tab1_1_1_1_5 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">IMPORTANT</td></tr><tr><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_3 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious risk of bias</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_4 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious inconsistency</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_5 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious indirectness</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_6 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>5</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_7 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1/30 (3.3%)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_9 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4/30 (13.3%)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.25 (0.03 to 2.11)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_11 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">100 fewer per 1000 (from 129 fewer to 148 more)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_4 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">⊕⊕⊖⊖ LOW</td><td headers="hd_h_ch9.appf.tab1_1_1_1_5 hd_b_ch9.appf.tab1_1_1_20_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">IMPORTANT</td></tr><tr><th headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_h_ch9.appf.tab1_1_1_2_3 hd_h_ch9.appf.tab1_1_1_2_4 hd_h_ch9.appf.tab1_1_1_2_5 hd_h_ch9.appf.tab1_1_1_2_6 hd_h_ch9.appf.tab1_1_1_2_7 hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_h_ch9.appf.tab1_1_1_2_9 hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_h_ch9.appf.tab1_1_1_2_11 hd_h_ch9.appf.tab1_1_1_1_4 hd_h_ch9.appf.tab1_1_1_1_5" id="hd_b_ch9.appf.tab1_1_1_24_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:middle;">Additional treatments required - emergency surgery</th></tr><tr><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_1 hd_b_ch9.appf.tab1_1_1_24_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_2 hd_b_ch9.appf.tab1_1_1_24_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Observational studies</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_3 hd_b_ch9.appf.tab1_1_1_24_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious risk of bias</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_4 hd_b_ch9.appf.tab1_1_1_24_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No serious inconsistency</td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_5 hd_b_ch9.appf.tab1_1_1_24_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>1</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_6 hd_b_ch9.appf.tab1_1_1_24_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>5</sup></td><td headers="hd_h_ch9.appf.tab1_1_1_1_1 hd_h_ch9.appf.tab1_1_1_2_7 hd_b_ch9.appf.tab1_1_1_24_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_8 hd_b_ch9.appf.tab1_1_1_24_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3/39 (7.7%)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_2 hd_h_ch9.appf.tab1_1_1_2_9 hd_b_ch9.appf.tab1_1_1_24_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1/24 (4.2%)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_10 hd_b_ch9.appf.tab1_1_1_24_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 1.85 (0.20 to 16.25)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_3 hd_h_ch9.appf.tab1_1_1_2_11 hd_b_ch9.appf.tab1_1_1_24_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35 more per 1000(33 fewer to 656 more)</td><td headers="hd_h_ch9.appf.tab1_1_1_1_4 hd_b_ch9.appf.tab1_1_1_24_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">⊕⊖⊖⊖ VERY LOW</td><td headers="hd_h_ch9.appf.tab1_1_1_1_5 hd_b_ch9.appf.tab1_1_1_24_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">IMPORTANT</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">CAR: carbetocin; CG: control group; CI: confidence interval; IG: intervention group; MID: minimal important difference; Mins: minutes; OXY: oxytocin; PPH: postpartum haemorrhage; RCT: randomised controlled trial; RR: risk ratio</p></div></dd></dl><dl class="bkr_refwrap"><dt>1</dt><dd><div id="ch9.appf.tab1_1"><p class="no_margin">The quality of the evidence was downgraded by 1 level for indirectness as one group included 10% triplets (as reported in the study)</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="ch9.appf.tab1_2"><p class="no_margin">The quality of the evidence was downgraded by 1 level because the 95% CI crosses the lower MID threshold as calculated for continuous variables</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="ch9.appf.tab1_3"><p class="no_margin">The quality of the evidence was downgraded by 1 level because the 95% CI crosses the upper MID threshold as calculated for continuous variables</p></div></dd></dl><dl class="bkr_refwrap"><dt>4</dt><dd><div id="ch9.appf.tab1_4"><p class="no_margin">All results here as presented in the study paper - though calculations suggest that N may have been reported the wrong way around (N=86 in oxytocin group and not the carbetocin group as reported; and N=80 in the carbetocin group and not oxytocin as reported)</p></div></dd></dl><dl class="bkr_refwrap"><dt>5</dt><dd><div id="ch9.appf.tab1_5"><p class="no_margin">The quality of the evidence was downgraded by 2 levels because the 95% CI crosses 2 default MID thresholds: crosses upper and lower boundaries for MID (0.8 to 1.25)</p></div></dd></dl><dl class="bkr_refwrap"><dt>6</dt><dd><div id="ch9.appf.tab1_6"><p class="no_margin">Data for number of women requiring one dose of methergine. Data also available for those requiring 2 doses of oxytocin: N=10/30 (33.3%)</p></div></dd></dl><dl class="bkr_refwrap"><dt>7</dt><dd><div id="ch9.appf.tab1_7"><p class="no_margin">The quality of the evidence was downgraded by 1 level because the 95% CI crosses 1 default MID threshold: crosses lower boundary for MID (0.8 to 1.25)</p></div></dd></dl></dl></div></div></div></article><article data-type="fig" id="figobch9appgfig1"><div id="ch9.appg.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%202.%20Flow%20diagram%20of%20economic%20article%20selection%20for%20the%20optimal%20managing%20the%20third%20stage%20of%20labour%20to%20reduce%20the%20risk%20of%20postpartum%20haemorrhage%20(PPH)%20in%20twin%20and%20triplet%20pregnancy.&p=BOOKS&id=578069_ch9appgf1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK578069/bin/ch9appgf1.jpg" alt="Figure 2. Flow diagram of economic article selection for the optimal managing the third stage of labour to reduce the risk of postpartum haemorrhage (PPH) in twin and triplet pregnancy." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 2</span><span class="title">Flow diagram of economic article selection for the optimal managing the third stage of labour to reduce the risk of postpartum haemorrhage (PPH) in twin and triplet pregnancy</span></h3></div></article><article data-type="table-wrap" id="figobch9appktab1"><div id="ch9.appk.tab1" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK578069/table/ch9.appk.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch9.appk.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Reason for Exclusion</th></tr></thead><tbody><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Amaya, S., Mattox, J., Tussey, C, Kang, P., Evaluating severity of postpartum hemorrhage retrospectively based on risk factors, Obstetrics and Gynecology, 129, 113S–114S, 2017</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Abstract only</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anorlu, Rose I, Maholwana, Babalwa, Hofmeyr, G Justus, Methods of delivering the placenta at caesarean section, Cochrane Database of Systematic Reviews, 2008</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison is not relevant to the protocol</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bayoumeu,F., Baka,N.E., Fresson,J., Monnier-Barbarino,P., Do prophylactic prostaglandins reduce the transfusion rate at cesarean section in high-order multiple pregnancies?, European Journal of Obstetrics, Gynecology, and Reproductive Biology, 111, 38–42, 2003</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison is not relevant to the protocol</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Begley, Cecily M, Gyte, Gillian MI, Devane, Declan, McGuire, William, Weeks, Andrew, Active versus expectant management for women in the third stage of labour, Cochrane Database of Systematic Reviews, 2015</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Results are not presented for twin or triplet pregnancies</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bombelli, F. M., Cavoretto, P., di Piazza, L., Valentini, G., Convenient use of carbetocin during 70 elective cae- sarean deliveries, Italian Journal of Gynaecology and Obstetrics, 23, 83–89, 2011</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Article in Italian</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bullough, C. H, Msuku, R. S, Karonde, L., Early suckling and postpartum haemorrhage: controlled trial in deliveries by traditional birth attendants, Lancet, 2, 522–5, 1989</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison is not relevant to the protocol</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Campbell, D., A review of maternal complications of multiple pregnancy, Twin ResearchTwin Res, 4, 146–9, 2001</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Narrative review</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dahlke, J. D., Mendez-Figueroa, H., Maggio, L., Hauspurg, A. K., Sperling, J. D., Chauhan, S. P., Rouse, D. J., Prevention and management of postpartum hemorrhage: a comparison of 4 national guidelines, American Journal of Obstetrics & Gynecology, 213, 76.e1–10, 2015</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No relevant results are presented for twin or triplet pregnancies</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">de Groot, A. N., Prevention of postpartum haemorrhage, Baillieres Clinical Obstetrics & Gynaecology, 9, 619–31, 1995</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Narrative review</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Demetz,J, Clouqueur,E, D’Haveloose,A, Staelen,P, Ducloy,A.S, Subtil,D., Systematic use of carbetocin during cesarean delivery of multiple pregnancies: a before-and-after study. [Erratum appears in Arch Gynecol Obstet. 2013 Jul;288(1):235 Note: Julie, Demetz [corrected to Demetz, Julie]; Elodie, Clouqueur [corrected to Clouqueur, Elodie]; Anne, D’Haveloose [corrected to D’Haveloose, Anne]; Pauline, Staelen [corrected to Staelen, Pauline]; Anne-sophie, Ducloy [corrected to Ducloy, Anne-Sophie]; Damien, Subtil [corrected to Subtil, Damien]], Archives of Gynecology and Obstetrics, 287, 875–880, 2013</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison is not relevant to the protocol</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Foley, A., Gunter, A., Nunes, K. J., Shahul, S., Scavone, B. M., Patients Undergoing Cesarean Delivery After Exposure to Oxytocin During Labor Require Higher Postpartum Oxytocin Doses, Anesthesia & AnalgesiaAnesth Analg, 126,920–924, 2018</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non relevant population</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gallos, ID, Papadopoulou A, Man R, Athanasopoulos N, Tobias A, Price MJ, Williams MJ, Diaz V, Pasquale J, Chamillard M, Widmer M, Tunçalp Ö, Hofmeyr GJ, Althabe F, Gülmezoglu AM, Vogel JP, Oladapo OT, Coomarasamy A. Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis, Cochrane Database of Systematic Reviews, 2018</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review. Includes singletons and twins, does not present data separately. Included one study of twins only, assessed for inclusion</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hofmeyr, G Justus, Gülmezoglu, A Metin, Novikova, Natalia, Lawrie, Theresa A, Postpartum misoprostol for preventing maternal mortality and morbidity, Cochrane Database of Systematic Reviews, 2013</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Results are not presented for twin or triplet pregnancies</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hofmeyr, G Justus, Mshweshwe, Nolundi T, Gülmezoglu, A Metin, Controlled cord traction for the third stage of labour, Cochrane Database of Systematic Reviews, 2015</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Results are not presented for twin or triplet pregnancies</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Liabsuetrakul, Tippawan, Choobun, Thanapan, Peeyananjarassri, Krantarat, Islam, Q Monir, Prophylactic use of ergot alkaloids in the third stage of labour, Cochrane Database of Systematic Reviews, 2007</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Results are not presented for twin or triplet pregnancies</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Liabsuetrakul, Tippawan, Choobun, Thanapan, Peeyananjarassri, Krantarat, Islam, Q Monir, Prophylactic use of ergot alkaloids in the third stage of labour, Cochrane Database of Systematic Reviews, 2018</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Includes any pregnancy expecting vaginal birth - no information on singleton/multiple pregnancies. Only one study listed mentions multiple gestation (as an exclusion criteria)</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">McDonald, Susan J, Prophylactic ergometrine-oxytocin versus oxytocin for the third stage of labour, Cochrane Database of Systematic Reviews, 2004</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Results are not presented for twin or triplet pregnancies</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">McDonald, Susan J, Middleton, Philippa, Dowswell, Therese, Morris, Peter S, Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes, Cochrane Database of Systematic Reviews, 2013</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCTs including women with multiple pregnancies excluded from review</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mikhailov, A., Shman, V., Kuznetsov, A., Romanovsky, A., Shlykova, A., Prevention and management of pph in multiple pregnancy, Twin Research and Human Genetics, 20 (6), 636, 2017</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Abstract only</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mori, Rintaro, Nardin, Juan Manuel, Yamamoto, Naoko, Carroli, Guillermo, Weeks, Andrew, Umbilical vein injection for the routine management of third stage of labour, Cochrane Database of Systematic Reviews, 2012</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Results are not presented separately for twin or triplet pregnancy</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Munn, M. B., Owen, J., Vincent, R., Wakefield, M., Chestnut, D. H., Hauth, J. C, Hofmeyr, G. J., Gulmezoglu, A. M., A higher dose of oxytocin was more effective than a standard dose, when infused over 30 min, in preventing uterine atony after cesarean delivery, Evidence-based Obstetrics and Gynecology, 4, 120–121, 2002</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Only 6% were multiple pregnancies</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Neimand,K.M, Gibstein,A, Rosenthal,A.H., Oxytocin in twin gestation, American Journal of Obstetrics and Gynecology, 99, 533–538, 1967</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison is not relevant to the protocol</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Novikova, Natalia, Hofmeyr, G Justus, Cluver, Catherine, Tranexamic acid for preventing postpartum haemorrhage, Cochrane Database of Systematic Reviews, 2015</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCTs including women with multiple pregnancies excluded from review</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pearson, G. A., Pepper, W., Russell, R., MacKenzie, I. Z., Retrospective study to investigate the possible relationship between excess blood loss at caesarean section and reduced intra-operative oxytocin dose, European Journal of Obstetrics, Gynecology, & Reproductive BiologyEur J Obstet Gynecol ReprodBiol, 196, 31–7,2016</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No relevant results are presented for twin or triplet pregnancies</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rabe, Heike, Diaz-Rossello, Jose Luis, Duley, Lelia, Dowswell, Therese, Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes, Cochrane Database of Systematic Reviews, 2012</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Results are not presented separately for twin or triplet pregnancy</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rossen,J., Okland,I., Nilsen,O.B., Eggebo,T.M., Is there an increase of postpartum hemorrhage, and is severe hemorrhage associated with more frequent use of obstetric interventions?, Acta Obstetricia et Gynecologica Scandinavica, 89, 1248–1255, 2010</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No relevant results are presented for twin or triplet pregnancies</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ruangkit, C., Leon, M., Hassen, K., Baker, K., Poeltler, D., Katheria, A., Maternal bleeding complications following early versus delayed umbilical cord clamping in multiple pregnancies, BMC Pregnancy and Childbirth, 18(1) (no pagination), 2018</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Early versus delayed cord clamping - timing of clamping is not included in the protocol</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ruangkit, C., Moroney, V., Viswanathan, S., Bhola, M., Safety and efficacy of delayed umbilical cord clamping in multiple and singleton premature infants - A quality improvement study, Journal of Neonatal-Perinatal Medicine, 8, 393–402, 2015</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No relevant results are presented for twin or triplet pregnancies</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Saviron-Cornudella, R., Esteban, L. M., Laborda-Gotor, R., Rodriguez-Solanilla, B., De Mucio, B., Sanz, G., Castan-Mateo, S., Maternal morbidity after implementation of a postpartum hemorrhage protocol including use of misoprostol, International Journal of Gynecology and Obstetrics, 140, 198–204, 2018</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cannot separate data for singleton and multiple pregnancies - only outcome available for multiples is haemoglobin(Hb) (not in protocol)</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sayed, W. E., Shirol, V., Kirkpatrick, A., Audit on the use of carbetocin for prevention of postpartum haemorrhage, BJOG: An International Journal of Obstetrics and Gynaecology, 121, 24–25, 2014</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Poster abstract - cost effectiveness analysis of carbetocin in UK</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sheldon,W.R., Durocher,J., Winikoff,B., Blum,J., Trussell,J., How effective are the components of active management of the third stage of labor?, BMC Pregnancy and Childbirth, 13, 46-, 2013</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No relevant results are presented for twin or triplet pregnancies</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Su, Lin-Lin, Chong, Yap-Seng, Samuel, Miny, Carbetocin for preventing postpartum haemorrhage, Cochrane Database of Systematic Reviews, 2012</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Results are not presented for twin and triplet pregnancies</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tunçalp, Özge, Hofmeyr, G Justus, Gulmezoglu, A Metin, Prostaglandinsfor preventing postpartum haemorrhage, Cochrane Database of Systematic Reviews, 2012</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No relevant results are presented for twin or triplet pregnancies</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Westhoff, Gina, Cotter, Amanda M, Tolosa, Jorge E, Prophylactic oxytocin for the third stage of labour to prevent postpartum haemorrhage, Cochrane Database of Systematic Reviews, 2013</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No relevant results are presented for twin or triplet pregnancies</td></tr><tr><td headers="hd_h_ch9.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wu, Lf, Liu, Y, Ruan, Y, Clinical study on prevention of postpartum hemorrhage of cesarean section using hemabat in high risk pregnant women, Zhonghua fu chan ke za zhi, 42, 577–581,2007</td><td headers="hd_h_ch9.appk.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">File sent from British Library inaccessible (a full-text copy of the article could not be obtained)</td></tr></tbody></table></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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