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Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
Figures and Tables -
Figure 1

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 1 Severe primary postpartum haemorrhage (PPH) at time of birth (clinically estimated or measured blood loss ≥ 1000 mL).
Figures and Tables -
Analysis 1.1

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 1 Severe primary postpartum haemorrhage (PPH) at time of birth (clinically estimated or measured blood loss ≥ 1000 mL).

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 4 Maternal Hb < 9 g/dL 24‐72 hours postpartum.
Figures and Tables -
Analysis 1.4

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 4 Maternal Hb < 9 g/dL 24‐72 hours postpartum.

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 5 Admission to neonatal special/intensive care.
Figures and Tables -
Analysis 1.5

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 5 Admission to neonatal special/intensive care.

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 6 Neonatal jaundice requiring phototherapy or exchange transfusion.
Figures and Tables -
Analysis 1.6

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 6 Neonatal jaundice requiring phototherapy or exchange transfusion.

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 10 Primary blood loss ≥ 500 mL at time of birth (clinically estimated or measured).
Figures and Tables -
Analysis 1.10

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 10 Primary blood loss ≥ 500 mL at time of birth (clinically estimated or measured).

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 13 Mean maternal blood loss (mL) at time of birth (clinically estimated or measured).
Figures and Tables -
Analysis 1.13

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 13 Mean maternal blood loss (mL) at time of birth (clinically estimated or measured).

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 16 Maternal blood transfusion.
Figures and Tables -
Analysis 1.16

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 16 Maternal blood transfusion.

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 18 Therapeutic uterotonics during third stage and/or within 24 hours.
Figures and Tables -
Analysis 1.18

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 18 Therapeutic uterotonics during third stage and/or within 24 hours.

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 19 Mean length of third stage.
Figures and Tables -
Analysis 1.19

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 19 Mean length of third stage.

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 20 Manual removal of placenta as defined by authors.
Figures and Tables -
Analysis 1.20

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 20 Manual removal of placenta as defined by authors.

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 21 Postnatal diastolic blood pressure > 90 mmHg between birth of baby and discharge from the labour ward..
Figures and Tables -
Analysis 1.21

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 21 Postnatal diastolic blood pressure > 90 mmHg between birth of baby and discharge from the labour ward..

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 22 Postnatal vomiting between birth of baby and discharge from the labour ward..
Figures and Tables -
Analysis 1.22

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 22 Postnatal vomiting between birth of baby and discharge from the labour ward..

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 23 Any analgesia between birth of the baby and discharge from labour ward.
Figures and Tables -
Analysis 1.23

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 23 Any analgesia between birth of the baby and discharge from labour ward.

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 25 Secondary blood loss/any vaginal bleeding needing treatment (after 24 hours and up to 6 weeks).
Figures and Tables -
Analysis 1.25

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 25 Secondary blood loss/any vaginal bleeding needing treatment (after 24 hours and up to 6 weeks).

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 27 Surgical evacuation of retained products of conception.
Figures and Tables -
Analysis 1.27

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 27 Surgical evacuation of retained products of conception.

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 28 Afterpains ‐ abdominal pain associated with the contracting uterus in the postpartum period..
Figures and Tables -
Analysis 1.28

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 28 Afterpains ‐ abdominal pain associated with the contracting uterus in the postpartum period..

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 29 Apgar score < 7 at 5 minutes.
Figures and Tables -
Analysis 1.29

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 29 Apgar score < 7 at 5 minutes.

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 30 Birthweight.
Figures and Tables -
Analysis 1.30

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 30 Birthweight.

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 38 Exclusive breastfeeding at discharge from hospital.
Figures and Tables -
Analysis 1.38

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 38 Exclusive breastfeeding at discharge from hospital.

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 40 Return to hospital as in‐ or outpatient because of bleeding (not pre‐specified).
Figures and Tables -
Analysis 1.40

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 40 Return to hospital as in‐ or outpatient because of bleeding (not pre‐specified).

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 41 Postnatal maternal mean Hb (outcome not pre‐specified).
Figures and Tables -
Analysis 1.41

Comparison 1 Active versus expectant management of 3rd stage of labour (all women), Outcome 41 Postnatal maternal mean Hb (outcome not pre‐specified).

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 1 Severe primary PPH at time of birth (clinically estimated or measured blood loss ≥ 1000 mL).
Figures and Tables -
Analysis 2.1

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 1 Severe primary PPH at time of birth (clinically estimated or measured blood loss ≥ 1000 mL).

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 4 Maternal Hb < 9 g/dL at 24‐72 hr.
Figures and Tables -
Analysis 2.4

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 4 Maternal Hb < 9 g/dL at 24‐72 hr.

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 5 Admission to neonatal special/intensive care.
Figures and Tables -
Analysis 2.5

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 5 Admission to neonatal special/intensive care.

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 6 Neonatal jaundice requiring phototherapy or exchange transfusion.
Figures and Tables -
Analysis 2.6

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 6 Neonatal jaundice requiring phototherapy or exchange transfusion.

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 10 Primary blood loss ≥ 500 mL at time of birth (clinically estimated or measured).
Figures and Tables -
Analysis 2.10

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 10 Primary blood loss ≥ 500 mL at time of birth (clinically estimated or measured).

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 13 Mean maternal blood loss (mL at the time of birth, clinically estimated or measured.
Figures and Tables -
Analysis 2.13

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 13 Mean maternal blood loss (mL at the time of birth, clinically estimated or measured.

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 16 Maternal blood transfusion.
Figures and Tables -
Analysis 2.16

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 16 Maternal blood transfusion.

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 18 Therapeutic uterotonics during third stage and/or within 24 hours.
Figures and Tables -
Analysis 2.18

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 18 Therapeutic uterotonics during third stage and/or within 24 hours.

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 19 Mean length of third stage.
Figures and Tables -
Analysis 2.19

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 19 Mean length of third stage.

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 20 Manual removal of placenta as defined by authors.
Figures and Tables -
Analysis 2.20

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 20 Manual removal of placenta as defined by authors.

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 21 Postnatal diastolic blood pressure > 90 mmHg between birth of baby and discharge from the labour ward..
Figures and Tables -
Analysis 2.21

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 21 Postnatal diastolic blood pressure > 90 mmHg between birth of baby and discharge from the labour ward..

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 22 Postnatal vomiting between birth of baby and discharge from the labour ward..
Figures and Tables -
Analysis 2.22

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 22 Postnatal vomiting between birth of baby and discharge from the labour ward..

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 23 Any analgesia between birth of the baby and up to discharge from labour ward.
Figures and Tables -
Analysis 2.23

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 23 Any analgesia between birth of the baby and up to discharge from labour ward.

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 25 Secondary blood loss/any vaginal bleeding needing treatment (after 24 hours and up to 6 weeks).
Figures and Tables -
Analysis 2.25

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 25 Secondary blood loss/any vaginal bleeding needing treatment (after 24 hours and up to 6 weeks).

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 27 Surgical evacuation of retained products of conception.
Figures and Tables -
Analysis 2.27

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 27 Surgical evacuation of retained products of conception.

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 28 Afterpains ‐ abdominal pain associated with the contracting uterus in the postpartum period..
Figures and Tables -
Analysis 2.28

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 28 Afterpains ‐ abdominal pain associated with the contracting uterus in the postpartum period..

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 30 Birthweight.
Figures and Tables -
Analysis 2.30

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 30 Birthweight.

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 40 Return to hospital as in‐ or outpatient because of bleeding (not pre‐specified).
Figures and Tables -
Analysis 2.40

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 40 Return to hospital as in‐ or outpatient because of bleeding (not pre‐specified).

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 41 Postnatal maternal mean Hb (outcome not pre‐specified).
Figures and Tables -
Analysis 2.41

Comparison 2 Active versus expectant management of 3rd stage of labour (women at low risk), Outcome 41 Postnatal maternal mean Hb (outcome not pre‐specified).

Comparison 10 Active versus mixed management (uterotonic after placental delivery, immediate cord clamping and no CCT)  , Outcome 1 Severe primary PPH at time of birth (clinically estimated or measured blood loss ≥ 1000 mL).
Figures and Tables -
Analysis 10.1

Comparison 10 Active versus mixed management (uterotonic after placental delivery, immediate cord clamping and no CCT)  , Outcome 1 Severe primary PPH at time of birth (clinically estimated or measured blood loss ≥ 1000 mL).

Comparison 10 Active versus mixed management (uterotonic after placental delivery, immediate cord clamping and no CCT)  , Outcome 10 Primary blood loss ≥ 500 mL at time of birth (clinically estimated or measured).
Figures and Tables -
Analysis 10.10

Comparison 10 Active versus mixed management (uterotonic after placental delivery, immediate cord clamping and no CCT)  , Outcome 10 Primary blood loss ≥ 500 mL at time of birth (clinically estimated or measured).

Comparison 10 Active versus mixed management (uterotonic after placental delivery, immediate cord clamping and no CCT)  , Outcome 16 Maternal blood transfusion.
Figures and Tables -
Analysis 10.16

Comparison 10 Active versus mixed management (uterotonic after placental delivery, immediate cord clamping and no CCT)  , Outcome 16 Maternal blood transfusion.

Comparison 10 Active versus mixed management (uterotonic after placental delivery, immediate cord clamping and no CCT)  , Outcome 17 Clinical signs of severe blood loss.
Figures and Tables -
Analysis 10.17

Comparison 10 Active versus mixed management (uterotonic after placental delivery, immediate cord clamping and no CCT)  , Outcome 17 Clinical signs of severe blood loss.

Comparison 10 Active versus mixed management (uterotonic after placental delivery, immediate cord clamping and no CCT)  , Outcome 18 Therapeutic uterotonics during third stage and/or within 24 hours.
Figures and Tables -
Analysis 10.18

Comparison 10 Active versus mixed management (uterotonic after placental delivery, immediate cord clamping and no CCT)  , Outcome 18 Therapeutic uterotonics during third stage and/or within 24 hours.

Comparison 10 Active versus mixed management (uterotonic after placental delivery, immediate cord clamping and no CCT)  , Outcome 19 Mean length of third stage.
Figures and Tables -
Analysis 10.19

Comparison 10 Active versus mixed management (uterotonic after placental delivery, immediate cord clamping and no CCT)  , Outcome 19 Mean length of third stage.

Comparison 11 Active versus mixed management (no routine uterotonic, early cord clamping, no CCT), Outcome 1 Severe primary PPH at time of birth (clinically estimated or measured blood loss ≥ 1000 mL).
Figures and Tables -
Analysis 11.1

Comparison 11 Active versus mixed management (no routine uterotonic, early cord clamping, no CCT), Outcome 1 Severe primary PPH at time of birth (clinically estimated or measured blood loss ≥ 1000 mL).

Comparison 11 Active versus mixed management (no routine uterotonic, early cord clamping, no CCT), Outcome 4 Maternal Hb < 9 g/dL at 24‐72 hr.
Figures and Tables -
Analysis 11.4

Comparison 11 Active versus mixed management (no routine uterotonic, early cord clamping, no CCT), Outcome 4 Maternal Hb < 9 g/dL at 24‐72 hr.

Comparison 11 Active versus mixed management (no routine uterotonic, early cord clamping, no CCT), Outcome 10 Primary blood loss ≥ 500 mL at time of birth (clinically estimated or measured).
Figures and Tables -
Analysis 11.10

Comparison 11 Active versus mixed management (no routine uterotonic, early cord clamping, no CCT), Outcome 10 Primary blood loss ≥ 500 mL at time of birth (clinically estimated or measured).

Comparison 11 Active versus mixed management (no routine uterotonic, early cord clamping, no CCT), Outcome 13 Mean maternal blood loss (mL) at time of birth (clinically estimated or measured).
Figures and Tables -
Analysis 11.13

Comparison 11 Active versus mixed management (no routine uterotonic, early cord clamping, no CCT), Outcome 13 Mean maternal blood loss (mL) at time of birth (clinically estimated or measured).

Comparison 11 Active versus mixed management (no routine uterotonic, early cord clamping, no CCT), Outcome 16 Maternal blood transfusion.
Figures and Tables -
Analysis 11.16

Comparison 11 Active versus mixed management (no routine uterotonic, early cord clamping, no CCT), Outcome 16 Maternal blood transfusion.

Comparison 11 Active versus mixed management (no routine uterotonic, early cord clamping, no CCT), Outcome 18 Therapeutic uterotonics during third stage and/or within 24 hours.
Figures and Tables -
Analysis 11.18

Comparison 11 Active versus mixed management (no routine uterotonic, early cord clamping, no CCT), Outcome 18 Therapeutic uterotonics during third stage and/or within 24 hours.

Comparison 11 Active versus mixed management (no routine uterotonic, early cord clamping, no CCT), Outcome 19 Mean length of third stage.
Figures and Tables -
Analysis 11.19

Comparison 11 Active versus mixed management (no routine uterotonic, early cord clamping, no CCT), Outcome 19 Mean length of third stage.

Comparison 11 Active versus mixed management (no routine uterotonic, early cord clamping, no CCT), Outcome 20 Manual removal of placenta as defined by authors.
Figures and Tables -
Analysis 11.20

Comparison 11 Active versus mixed management (no routine uterotonic, early cord clamping, no CCT), Outcome 20 Manual removal of placenta as defined by authors.

Comparison 11 Active versus mixed management (no routine uterotonic, early cord clamping, no CCT), Outcome 28 Not prespecified: afterpains at 2 hours after birth (id 20458).
Figures and Tables -
Analysis 11.28

Comparison 11 Active versus mixed management (no routine uterotonic, early cord clamping, no CCT), Outcome 28 Not prespecified: afterpains at 2 hours after birth (id 20458).

Comparison 11 Active versus mixed management (no routine uterotonic, early cord clamping, no CCT), Outcome 29 Not pre‐specified: afterpains the day after birth (id 20458).
Figures and Tables -
Analysis 11.29

Comparison 11 Active versus mixed management (no routine uterotonic, early cord clamping, no CCT), Outcome 29 Not pre‐specified: afterpains the day after birth (id 20458).

Comparison 11 Active versus mixed management (no routine uterotonic, early cord clamping, no CCT), Outcome 31 Birthweight.
Figures and Tables -
Analysis 11.31

Comparison 11 Active versus mixed management (no routine uterotonic, early cord clamping, no CCT), Outcome 31 Birthweight.

Comparison 11 Active versus mixed management (no routine uterotonic, early cord clamping, no CCT), Outcome 42 Postnatal maternal mean Hb (outcome not pre‐specified).
Figures and Tables -
Analysis 11.42

Comparison 11 Active versus mixed management (no routine uterotonic, early cord clamping, no CCT), Outcome 42 Postnatal maternal mean Hb (outcome not pre‐specified).

Comparison 11 Active versus mixed management (no routine uterotonic, early cord clamping, no CCT), Outcome 43 Severe primary PPH after placental delivery and up to 2 hours (clinically estimated or measured blood loss ≥ 1000 mL) ‐ not pre‐specified.
Figures and Tables -
Analysis 11.43

Comparison 11 Active versus mixed management (no routine uterotonic, early cord clamping, no CCT), Outcome 43 Severe primary PPH after placental delivery and up to 2 hours (clinically estimated or measured blood loss ≥ 1000 mL) ‐ not pre‐specified.

Comparison 11 Active versus mixed management (no routine uterotonic, early cord clamping, no CCT), Outcome 44 Severe primary PPH at time of birth and up to 2 hours (clinically estimated or measured blood loss ≥1000 mL) ‐ not pre‐specified.
Figures and Tables -
Analysis 11.44

Comparison 11 Active versus mixed management (no routine uterotonic, early cord clamping, no CCT), Outcome 44 Severe primary PPH at time of birth and up to 2 hours (clinically estimated or measured blood loss ≥1000 mL) ‐ not pre‐specified.

Comparison 11 Active versus mixed management (no routine uterotonic, early cord clamping, no CCT), Outcome 45 Mean blood loss (mL) (clinically estimated or measured at birth and up to 2 hours (not pre‐specified).
Figures and Tables -
Analysis 11.45

Comparison 11 Active versus mixed management (no routine uterotonic, early cord clamping, no CCT), Outcome 45 Mean blood loss (mL) (clinically estimated or measured at birth and up to 2 hours (not pre‐specified).

Comparison 12 Active versus mixed management (no routine uterotonic, early cord clamping, CCT), Outcome 4 Maternal Hb < 9 g/dL at 24‐72 hr.
Figures and Tables -
Analysis 12.4

Comparison 12 Active versus mixed management (no routine uterotonic, early cord clamping, CCT), Outcome 4 Maternal Hb < 9 g/dL at 24‐72 hr.

Comparison 12 Active versus mixed management (no routine uterotonic, early cord clamping, CCT), Outcome 19 Mean length of third stage.
Figures and Tables -
Analysis 12.19

Comparison 12 Active versus mixed management (no routine uterotonic, early cord clamping, CCT), Outcome 19 Mean length of third stage.

Comparison 12 Active versus mixed management (no routine uterotonic, early cord clamping, CCT), Outcome 20 Manual removal of placenta as defined by authors.
Figures and Tables -
Analysis 12.20

Comparison 12 Active versus mixed management (no routine uterotonic, early cord clamping, CCT), Outcome 20 Manual removal of placenta as defined by authors.

Summary of findings for the main comparison. Active versus expectant management of the third stage of labour (all women)

Active versus expectant management of the third stage of labour (all women)

Population: all women who expected a vaginal birth at 24 weeks' gestation or later
Intervention: active management of the third stage of labour
Comparison: expectant management of the third stage of labour

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Expectant management of the third stage of labour

Active management of the third stage of labour

Severe primary postpartum haemorrhage (PPH) (clinically estimated or measured blood lossto 1000 mL at time of birth)

24 per 1000

8 per 1000
(3 to 21)

RR 0.34
(0.14 to 0.87)

4636
(3 studies)

⊕⊝⊝⊝
very low1

Very severe primary PPH (clinically estimated or measured blood lossto 2500 mL at time of birth)

See comment

See comment

Not estimable

0
(0)

See comment

No data

Maternal mortality

See comment

See comment

Not estimable

0
(0)

See comment

No data

Maternal Hb < 9 g/dL 24 to 72 hours postpartum

71 per 1000

36 per 1000
(21 to 59)

RR 0.5
(0.3 to 0.83)

1572
(2 studies)

⊕⊕⊝⊝
low2

Admission to neonatal special/intensive care

52 per 1000

42 per 1000
(31 to 58)

RR 0.81
(0.6 to 1.11)

3207
(2 studies)

⊕⊕⊝⊝
low3

Neonatal jaundice requiring phototherapy or exchange transfusion

49 per 1000

47 per 1000
(27 to 83)

RR 0.96
(0.55 to 1.68)

3142
(2 studies)

⊕⊝⊝⊝
very low4

Neonatal polycythaemia treated with dilutional exchange transfusion

See comment

See comment

Not estimable

0
(0)

See comment

No data

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Risk of bias: of the 3 trials providing data for this outcome, all 3 are at low risk of bias for sequence generation (selection bias), allocation concealment (selection bias) and for incomplete outcome data (attrition bias). 2 are at low risk of selective reporting (reporting bias) and 1 is unclear. 1 study is at high risk of other bias (see 'Risk of bias' tables).
Inconsistency: there is some overlap of confidence intervals of the 3 trials. However, Tau² = 0.38, the P value for the Chi² test of heterogeneity is 0.08 and I² = 60%. These suggest the presence of heterogeneity, which cannot be explained by any of the subgroups or sensitivity analyses performed.
Indirectness: directly answers the question.
Imprecision: total (cumulative) sample size 4636 is less than the optimal information size (OIS) of 18,590 (assuming α = 0.05, 1‐β = 0.80, relative risk reduction (RRR) of 25% from control event rate).

2Risk of bias: of the 2 trials providing data for this outcome, both are at low risk of bias for sequence generation (selection bias) and allocation concealment (selection bias), 1 is at low risk of bias for incomplete outcome data (attrition bias) while the other is high‐risk. 1 is at high‐‐risk of selective reporting (reporting bias) and 1 is unclear. Both studies are at high risk of other bias (see 'Risk of bias' tables).
Inconsistency: the confidence intervals of the 2 trials overlap. Tau² = 0.02, the P value for the Chi² test of heterogeneity is 0.31 and I² = 3%. Although Tau² is non‐zero, tests suggest an absence of unexplained heterogeneity.
Indirectness: directly answers the question.
Imprecision: total (cumulative) sample size 1572 is less than the optimal information size (OIS) of 5804 (assuming α = 0.05, 1‐β = 0.80, RRR of 25% from control event rate).
Publication bias: assessment of funnel plot asymmetry not performed due to < 10 studies included for this outcome.

3Risk of bias: of the 2 trials providing data for this outcome, both are at low risk of bias for sequence generation (selection bias), allocation concealment (selection bias) and for incomplete outcome data (attrition bias). 1 is at low‐risk of selective reporting (reporting bias) and 1 is unclear. 1 study is at high risk of other bias and the other is at low risk of bias (see 'Risk of bias' tables).
Inconsistency: the confidence intervals of the 2 trials overlap. Heterogeneity: Tau² = 0.00; Chi² P value = 0.40, I² = 0%. This suggests an absence of unexplained heterogeneity.
Indirectness: directly answers the question.
Imprecision: total (cumulative) sample size 3207 is less than the optimal information size (OIS) of 8066 (assuming α = 0.05, 1‐β = 0.80, RRR of 25% from control event rate).
Publication bias: assessment of funnel plot asymmetry not performed due to < 10 studies included for this outcome.

4Risk of bias: Of the 2 trials providing data for this outcome, both are at low risk of bias for sequence generation (selection bias), allocation concealment (selection bias) and for incomplete outcome data (attrition bias). 1 is at low‐risk of selective reporting (reporting bias) and 1 is unclear. 1 study is at high risk of other bias and the other is at low risk of bias (see 'Risk of bias' tables).
Inconsistency: there is some overlap of confidence intervals of the 2 trials. However, Heterogeneity: Tau² = 0.11, P value for heterogeneity = 0.09) and I² = 66%. These suggest the presence of heterogeneity, which cannot be explained by any of the subgroups or sensitivity analyses performed.
Indirectness: directly answers the question.
Imprecision: total (cumulative) sample size 3142 is less than the optimal information size (OIS) of 8584 (assuming α = 0.05, 1‐β = 0.80, RRR of 25% from control event rate).
Publication bias: assessment of funnel plot asymmetry not performed due to < 10 studies included for this outcome.

Figures and Tables -
Summary of findings for the main comparison. Active versus expectant management of the third stage of labour (all women)
Table 1. Terms and definitions used in this review

Terms

Definitions used in this review

Expectant management of third stage of labour

1. A prophylactic uterotonic agent is not administered;
2. the umbilical cord is neither clamped nor cut until the placenta has been delivered or until cord pulsation has ceased; and
3. the placenta is delivered spontaneously with the aid of gravity and sometimes by maternal effort.

Active management of third stage of labour

1. The routine administration of a prophylactic uterotonic drug just before, with, or immediately after, the birth of the baby;
2. early cord clamping and cutting; and
3. controlled cord traction to deliver the placenta.

Mixed management of third stage of labour

A mixture of some of the components of both active and expectant management of third stage, but without exclusively containing all the components of either. There can be a number of different mixed third stage managements, for example:
1. early prophylactic uterotonic drug, cord clamping when pulsation has ceased and controlled cord traction;
2. delayed prophylactic uterotonic drug, cord clamping when pulsation has ceased and controlled cord traction.

Early prophylactic uterotonic

Prophylactic uterotonic drug administered just before, with, or immediately after, the birth of the infant.

Delayed prophylactic uterotonic

Prophylactic uterotonic drug administered after the cord pulsation has ceased.

Early cord clamping

The application of a clamp to the umbilical cord within 60 seconds of the birth of the infant (McDonald 2013).

Delayed cord clamping

The application of a clamp to the umbilical cord greater than 1 minute after birth or when cord pulsation has ceased (McDonald 2013).

Sarnat staging for hypoxic ischaemic encephalopathy (Sarnat 1976)

Stage 1 (mild): hyper‐alertness, hyper‐reflexia, dilated pupils, tachycardia, absence of seizures.

Stage 2 (moderate): lethargy, hyper‐reflexia, miosis, bradycardia, seizures, hypotonia with weak suck and Moro reflexes.

Stage 3 (severe): stupor, flaccidity, small to mid‐position pupils which react poorly to light, decreased stretch reflexes, hypothermia and absent Moro.

Figures and Tables -
Table 1. Terms and definitions used in this review
Table 2. Varying managements used in studies compared with study protocols

Active management protocol

Expectant management protocol

Active management used

Expectant management used

Prendiville 1988

(Bristol trial)

• IM syntometrine (5 units oxytocin + 0.5 mg ergometrine)  (IM 10 units oxytocin if raised BP) Immediately after birth of anterior shoulder.

• Clamp cord 30 seconds after birth.

• CCT when uterus contracted.

• Try not to give oxytocic.

• Try to leave cord attached to baby until placenta delivered.

• Try not to use CCT or any manual interference with uterus at the fundus.

• Encourage mother to adopt posture aiding delivery with gravity.

• If placenta not delivered spontaneously wait, try putting baby to breast, and encourage maternal effort as above.

• Full active management (99%).

• 99% cord clamped and cut before delivery of placenta.

• 99% CCT.

• 217 (26%) upright.

 

• Full expectant management 403 (48%).

• Full active management 168 (20%).

• 278 (32%) had mixed management.

• Cord left unclamped till pulsation ceased 48%.

• Placenta delivered by maternal effort 60% and CCT 40%.

• 416 (49%) upright.

• 30% received uterotonic for treatment.

Begley 1990

(Dublin trial)

• IV ergometrine 0.5 mg immediately following birth.

• Try to clamp cord within 30 seconds.

• When uterus contracted, attempt CCT.

• Try not to give any special instructions re posture.

 

• No oxytocic drug routinely.

• Try to leave cord attached to baby until pulsation has ceased.

• Placenta may be delivered by maternal effort or gentle controlled cord traction once separated.

• Encourage mother to breastfeed. Help her to kneel/sit/squat.

• All given IV ergometrine before delivery of placenta.

• 89% cord clamped and cut.

• 93% CCT and 5% maternal effort.

• 7% upright and 93% recumbent.

• 14% were given ergometrine for treatment, not prophylactically, 6 (0.83%) before placenta delivered.

• Cord left unclamped till pulsation ceased 42%.

• Placenta delivered by maternal effort 32% and gentle CCT 66%.

• 11% upright.

Rogers 1998

(Hinchingbrooke trial)

•IM syntometrine (5 units oxytocin + 0.5 mg ergometrine)  (IM 10 units oxytocin if raised blood pressure).

• As soon as possible after birth of anterior shoulder (within 2 minutes of birth).

• Immediate cord clamping and cutting.

• CCT or maternal effort.

• Women randomised to upright and recumbent in both arms.

• No uterotonic drug.

• No cord clamping until after pulsation ceased.

• Delivery of placenta within 1 hour by maternal effort.

• 699 (93.4%) had full active management.

• 2 (0.3%) had fully expectant management.

• 47 (6.2%) had mixed.

• 95% given prophylactic uterotonic before delivery of placenta.

• 93% cord clamped before pulsation ceased.

• 46% CCT.

• 44% upright (when placenta delivered).

• 488 (63.9%) had full expectant management.

• 19 (2.5%) had fully active management.

• 257 (33.6%) had mixed.

• 21% received oxytocic for treatment, 2.5% prophylactically.

• Cord left unclamped till pulsation ceased 70%.

• Placenta delivered by CCT 12%.

• 43% upright (when placenta delivered).

Thilaganathan 1993(Brighton trial)

• Syntometrine 1 mL (IM or IV, route not specified).

• As soon as baby born.

• Cord was “immediately clamped”.

• Placenta delivered with CCT.

 

• No oxytocic.

• Cord not cut or clamped until after pulsation ceased (unless there were contraindications).

• Deliver placenta by maternal effort after signs of separation. “when the placenta could be felt in the vagina, the midwife could then assist delivery of the placenta”.

• Upright position encouraged.

• No information.

• No information.

Khan 1997

(Abu Dhabi trial)

• IM oxytocin 10 units at delivery of anterior shoulder.

• Immediate cord clamping and cutting.

• CCT as soon as the uterus was contracted firmly ‐ repeated every 2‐3 minutes.

 

 

• No oxytocic prior to delivery of placenta.

• Cord clamped and cut after delivery.

• No CCT.

• No fundal massage.

• Maternal expulsion after signs of separation.

• IV infusion of oxytocin 10 units in 500 mL normal saline given slowly.

• No information.

• No information.

BP: blood pressure
CCT: controlled cord traction
IM: intramuscular
IV: intravenous

Figures and Tables -
Table 2. Varying managements used in studies compared with study protocols
Comparison 1. Active versus expectant management of 3rd stage of labour (all women)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Severe primary postpartum haemorrhage (PPH) at time of birth (clinically estimated or measured blood loss ≥ 1000 mL) Show forest plot

3

4636

Risk Ratio (M‐H, Random, 95% CI)

0.34 [0.14, 0.87]

1.1 High‐income setting

3

4636

Risk Ratio (M‐H, Random, 95% CI)

0.34 [0.14, 0.87]

1.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2 Very severe primary PPH at time of birth (clinically estimated or measured blood loss ≥ 2500 mL)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.1 High‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3 Maternal mortality

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4 Maternal Hb < 9 g/dL 24‐72 hours postpartum Show forest plot

2

1572

Risk Ratio (M‐H, Random, 95% CI)

0.50 [0.30, 0.83]

4.1 High‐income setting

2

1572

Risk Ratio (M‐H, Random, 95% CI)

0.50 [0.30, 0.83]

4.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5 Admission to neonatal special/intensive care Show forest plot

2

3207

Risk Ratio (M‐H, Random, 95% CI)

0.81 [0.60, 1.11]

5.1 High‐income setting 

2

3207

Risk Ratio (M‐H, Random, 95% CI)

0.81 [0.60, 1.11]

5.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6 Neonatal jaundice requiring phototherapy or exchange transfusion Show forest plot

2

3142

Risk Ratio (M‐H, Random, 95% CI)

0.96 [0.55, 1.68]

6.1 High‐income setting 

2

3142

Risk Ratio (M‐H, Random, 95% CI)

0.96 [0.55, 1.68]

6.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7 Neonatal polycythaemia treated with dilutional exchange transfusion

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8 Severe primary PPH after placental delivery and up to 24 hours (clinically estimated or measured blood loss ≥ 1000 mL)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8.1 High‐income setting  

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8.2 Low‐income setting  

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

9 Severe primary PPH at time of birth and up to 24 hours (clinically estimated or measured blood loss ≥ 1000 mL)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

9.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

9.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

10 Primary blood loss ≥ 500 mL at time of birth (clinically estimated or measured) Show forest plot

3

4636

Risk Ratio (M‐H, Random, 95% CI)

0.34 [0.27, 0.44]

10.1 High‐income setting 

3

4636

Risk Ratio (M‐H, Random, 95% CI)

0.34 [0.27, 0.44]

10.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

11 Primary blood loss ≥ 500 mL after delivery of placenta and up to 24 hours (clinically estimated or measured)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

11.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

11.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

12 Primary blood loss ≥ 500 mL at time of birth and up to 24 hours (clinically estimated or measured)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

12.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

12.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

13 Mean maternal blood loss (mL) at time of birth (clinically estimated or measured) Show forest plot

2

2941

Mean Difference (IV, Random, 95% CI)

‐78.80 [‐95.96, ‐61.64]

13.1 High‐income setting 

2

2941

Mean Difference (IV, Random, 95% CI)

‐78.80 [‐95.96, ‐61.64]

13.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

14 Mean maternal blood loss (mL) after delivery of placenta and up to 24 hours (clinically estimated or measured)

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

14.1 High‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

14.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

15 Mean maternal blood loss (mL at time of birth and up to 24 hours (clinically estimated or measured)

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

15.1 High‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

15.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

16 Maternal blood transfusion Show forest plot

4

4829

Risk Ratio (M‐H, Random, 95% CI)

0.35 [0.22, 0.55]

16.1 High‐income setting 

4

4829

Risk Ratio (M‐H, Random, 95% CI)

0.35 [0.22, 0.55]

16.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

17 Clinical signs of severe blood loss

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

17.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

17.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

18 Therapeutic uterotonics during third stage and/or within 24 hours Show forest plot

4

4829

Risk Ratio (M‐H, Random, 95% CI)

0.19 [0.15, 0.23]

18.1 High‐income setting 

4

4829

Risk Ratio (M‐H, Random, 95% CI)

0.19 [0.15, 0.23]

18.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

19 Mean length of third stage Show forest plot

1

1429

Mean Difference (IV, Random, 95% CI)

‐0.30 [‐1.87, 1.27]

19.1 High‐income setting 

1

1429

Mean Difference (IV, Random, 95% CI)

‐0.30 [‐1.87, 1.27]

19.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

20 Manual removal of placenta as defined by authors Show forest plot

4

4829

Risk Ratio (M‐H, Random, 95% CI)

1.78 [0.57, 5.56]

20.1 High‐income setting 

4

4829

Risk Ratio (M‐H, Random, 95% CI)

1.78 [0.57, 5.56]

20.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

21 Postnatal diastolic blood pressure > 90 mmHg between birth of baby and discharge from the labour ward. Show forest plot

3

4636

Risk Ratio (M‐H, Random, 95% CI)

4.10 [1.63, 10.30]

21.1 High‐income setting 

3

4636

Risk Ratio (M‐H, Random, 95% CI)

4.10 [1.63, 10.30]

21.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

22 Postnatal vomiting between birth of baby and discharge from the labour ward. Show forest plot

3

4636

Risk Ratio (M‐H, Random, 95% CI)

2.47 [1.36, 4.48]

22.1 High‐income setting 

3

4636

Risk Ratio (M‐H, Random, 95% CI)

2.47 [1.36, 4.48]

22.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

23 Any analgesia between birth of the baby and discharge from labour ward Show forest plot

1

1429

Risk Ratio (M‐H, Random, 95% CI)

2.53 [1.34, 4.78]

23.1 High‐income setting 

1

1429

Risk Ratio (M‐H, Random, 95% CI)

2.53 [1.34, 4.78]

23.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

24 Women's assessment of pain during third stage as reported by authors.

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

24.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

24.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

25 Secondary blood loss/any vaginal bleeding needing treatment (after 24 hours and up to 6 weeks) Show forest plot

3

4636

Risk Ratio (M‐H, Random, 95% CI)

1.10 [0.40, 2.99]

25.1 High‐income setting

3

4636

Risk Ratio (M‐H, Random, 95% CI)

1.10 [0.40, 2.99]

25.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

26 Amount of lochia either estimated or measured after 24 hours and up to discharge from hospital.

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

26.1 High‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

26.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

27 Surgical evacuation of retained products of conception Show forest plot

3

4636

Risk Ratio (M‐H, Random, 95% CI)

0.74 [0.32, 1.71]

27.1 High‐income setting 

3

4636

Risk Ratio (M‐H, Random, 95% CI)

0.74 [0.32, 1.71]

27.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

28 Afterpains ‐ abdominal pain associated with the contracting uterus in the postpartum period. Show forest plot

1

1429

Risk Ratio (M‐H, Random, 95% CI)

2.53 [1.34, 4.78]

28.1 High‐income setting 

1

1429

Risk Ratio (M‐H, Random, 95% CI)

2.53 [1.34, 4.78]

28.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

29 Apgar score < 7 at 5 minutes Show forest plot

1

1695

Risk Ratio (M‐H, Random, 95% CI)

1.00 [0.38, 2.66]

29.1 High‐income setting 

1

1695

Risk Ratio (M‐H, Random, 95% CI)

1.00 [0.38, 2.66]

29.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

30 Birthweight Show forest plot

2

3207

Mean Difference (IV, Random, 95% CI)

‐76.90 [‐108.51, ‐45.30]

30.1 High‐income setting 

2

3207

Mean Difference (IV, Random, 95% CI)

‐76.90 [‐108.51, ‐45.30]

30.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

31 Neonatal encephalopathy assessed using Sarnat staging (Sarnat 1976; Table 1). 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

31.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

31.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

32 Neonatal mortality

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

32.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

32.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

33 Intraventricular haemorrhage ‐ Papille grade III/IV ‐ (for infants born before 34 weeks' gestation only).

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

33.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

33.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

34 Number of infants who received a red blood cell transfusion.

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

34.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

34.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

35 Infant Hb level at 24 to 72 hours

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

35.1 High‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

35.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

36 Infant Hb level at 3‐6 months

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

36.1 High‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

36.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

37 Infant iron indices (ferritin) at 3 to 6 months.

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

37.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

37.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

38 Exclusive breastfeeding at discharge from hospital Show forest plot

1

1695

Risk Ratio (M‐H, Random, 95% CI)

1.01 [0.96, 1.07]

38.1 High‐income setting 

1

1695

Risk Ratio (M‐H, Random, 95% CI)

1.01 [0.96, 1.07]

38.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

39 Neurodevelopmental, cognitive or developmental outcomes assessed after age 18 months.

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

39.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

39.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

40 Return to hospital as in‐ or outpatient because of bleeding (not pre‐specified) Show forest plot

2

2941

Risk Ratio (M‐H, Random, 95% CI)

2.21 [1.29, 3.79]

40.1 High‐income setting

2

2941

Risk Ratio (M‐H, Random, 95% CI)

2.21 [1.29, 3.79]

40.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

41 Postnatal maternal mean Hb (outcome not pre‐specified) Show forest plot

3

4062

Mean Difference (IV, Random, 95% CI)

0.52 [0.44, 0.60]

41.1 High‐income setting 

3

4062

Mean Difference (IV, Random, 95% CI)

0.52 [0.44, 0.60]

41.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 1. Active versus expectant management of 3rd stage of labour (all women)
Comparison 2. Active versus expectant management of 3rd stage of labour (women at low risk)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Severe primary PPH at time of birth (clinically estimated or measured blood loss ≥ 1000 mL) Show forest plot

2

2941

Risk Ratio (M‐H, Random, 95% CI)

0.31 [0.05, 2.17]

1.1 High‐income setting

2

2941

Risk Ratio (M‐H, Random, 95% CI)

0.31 [0.05, 2.17]

1.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2 Very severe primary PPH at time of birth (clinically estimated or measured blood loss ≥ 2500 mL)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.1 High‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3 Maternal mortality

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4 Maternal Hb < 9 g/dL at 24‐72 hr Show forest plot

1

193

Risk Ratio (M‐H, Random, 95% CI)

0.17 [0.02, 1.47]

4.1 High‐income setting

1

193

Risk Ratio (M‐H, Random, 95% CI)

0.17 [0.02, 1.47]

4.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5 Admission to neonatal special/intensive care Show forest plot

1

1512

Risk Ratio (M‐H, Random, 95% CI)

1.02 [0.55, 1.88]

5.1 High‐income setting 

1

1512

Risk Ratio (M‐H, Random, 95% CI)

1.02 [0.55, 1.88]

5.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6 Neonatal jaundice requiring phototherapy or exchange transfusion Show forest plot

1

1447

Risk Ratio (M‐H, Random, 95% CI)

1.31 [0.78, 2.18]

6.1 High‐income setting 

1

1447

Risk Ratio (M‐H, Random, 95% CI)

1.31 [0.78, 2.18]

6.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7 Neonatal polycythaemia treated with dilutional exchange transfusion

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8 Severe primary PPH after placental delivery and up to 24 hours (clinically estimated or measured blood loss ≥ 1000 mL)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8.1 High‐income setting  

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8.2 Low‐income setting  

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

9 Severe primary PPH at time of birth and up to 24 hours (clinically estimated or measured blood loss ≥ 1000 mL)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

9.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

9.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

10 Primary blood loss ≥ 500 mL at time of birth (clinically estimated or measured) Show forest plot

2

2941

Risk Ratio (M‐H, Random, 95% CI)

0.33 [0.20, 0.56]

10.1 High‐income setting 

2

2941

Risk Ratio (M‐H, Random, 95% CI)

0.33 [0.20, 0.56]

10.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

11 Primary blood loss ≥ 500 mL after delivery of placenta and up to 24 hours (clinically estimated or measured)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

11.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

11.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

12 Primary blood loss ≥ 500 mL at time of birth and up to 24 hours (clinically estimated or measured)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

12.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

12.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

13 Mean maternal blood loss (mL at the time of birth, clinically estimated or measured Show forest plot

2

2941

Mean Difference (IV, Random, 95% CI)

‐78.80 [‐95.96, ‐61.64]

13.1 High‐income setting 

2

2941

Mean Difference (IV, Random, 95% CI)

‐78.80 [‐95.96, ‐61.64]

13.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

14 Mean maternal blood loss (mL) after delivery of placenta and up to 24 hours (clinically estimated or measured)

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

14.1 High‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

14.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

15 Mean maternal blood loss (mL) at time of birth and up to 24 hours (clinically estimated or measured)

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

15.1 High‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

15.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

16 Maternal blood transfusion Show forest plot

3

3134

Risk Ratio (M‐H, Random, 95% CI)

0.30 [0.10, 0.88]

16.1 High‐income setting 

3

3134

Risk Ratio (M‐H, Random, 95% CI)

0.30 [0.10, 0.88]

16.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

17 Clinical signs of severe blood loss

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

17.1 High‐income setting  

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

17.2 Low‐income setting  

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

18 Therapeutic uterotonics during third stage and/or within 24 hours Show forest plot

3

3134

Risk Ratio (M‐H, Random, 95% CI)

0.15 [0.11, 0.21]

18.1 High‐income setting 

3

3134

Risk Ratio (M‐H, Random, 95% CI)

0.15 [0.11, 0.21]

18.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

19 Mean length of third stage Show forest plot

1

1429

Mean Difference (IV, Random, 95% CI)

‐0.30 [‐1.87, 1.27]

19.1 High‐income setting 

1

1429

Mean Difference (IV, Random, 95% CI)

‐0.30 [‐1.87, 1.27]

19.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

20 Manual removal of placenta as defined by authors Show forest plot

3

3134

Risk Ratio (M‐H, Random, 95% CI)

3.58 [0.42, 30.61]

20.1 High‐income setting 

3

3134

Risk Ratio (M‐H, Random, 95% CI)

3.58 [0.42, 30.61]

20.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

21 Postnatal diastolic blood pressure > 90 mmHg between birth of baby and discharge from the labour ward. Show forest plot

2

2941

Risk Ratio (M‐H, Random, 95% CI)

7.00 [2.99, 16.43]

21.1 High‐income setting 

2

2941

Risk Ratio (M‐H, Random, 95% CI)

7.00 [2.99, 16.43]

21.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

22 Postnatal vomiting between birth of baby and discharge from the labour ward. Show forest plot

2

2941

Risk Ratio (M‐H, Random, 95% CI)

5.63 [0.69, 46.08]

22.1 High‐income setting 

2

2941

Risk Ratio (M‐H, Random, 95% CI)

5.63 [0.69, 46.08]

22.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

23 Any analgesia between birth of the baby and up to discharge from labour ward Show forest plot

1

1429

Risk Ratio (M‐H, Random, 95% CI)

2.53 [1.34, 4.78]

23.1 High‐income setting 

1

1429

Risk Ratio (M‐H, Random, 95% CI)

2.53 [1.34, 4.78]

23.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

24 Women's assessment of pain during third stage as reported by authors.

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

24.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

24.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

25 Secondary blood loss/any vaginal bleeding needing treatment (after 24 hours and up to 6 weeks) Show forest plot

2

2941

Risk Ratio (M‐H, Random, 95% CI)

1.78 [0.69, 4.60]

25.1 High‐income setting

2

2941

Risk Ratio (M‐H, Random, 95% CI)

1.78 [0.69, 4.60]

25.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

26 Amount of lochia either estimated or measured after 24 hours and up to discharge from hospital.

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

26.1 High‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

26.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

27 Surgical evacuation of retained products of conception Show forest plot

2

2941

Risk Ratio (M‐H, Random, 95% CI)

0.69 [0.12, 3.98]

27.1 High‐income setting 

2

2941

Risk Ratio (M‐H, Random, 95% CI)

0.69 [0.12, 3.98]

27.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

28 Afterpains ‐ abdominal pain associated with the contracting uterus in the postpartum period. Show forest plot

1

1429

Risk Ratio (M‐H, Random, 95% CI)

2.53 [1.34, 4.78]

28.1 High‐income setting 

1

1429

Risk Ratio (M‐H, Random, 95% CI)

2.53 [1.34, 4.78]

28.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

29 Apgar score < 7 at 5 minutes

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

29.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

29.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

30 Birthweight Show forest plot

1

1512

Mean Difference (IV, Random, 95% CI)

‐67.0 [‐114.13, ‐19.87]

30.1 High‐income setting 

1

1512

Mean Difference (IV, Random, 95% CI)

‐67.0 [‐114.13, ‐19.87]

30.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

31 Neonatal encephalopathy assessed using Sarnat staging (Sarnat 1976; Table 1).

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

31.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

31.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

32 Neonatal mortality

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

32.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

32.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

33 Intraventricular haemorrhage ‐ Papille grade III/IV ‐ (for infants born before 34 weeks' gestation only).

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

33.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

33.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

34 Number of infants exposed to one or more red blood cell transfusions

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

34.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

34.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

35 Infant Hb level at 24 to 72 hours

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

35.1 High‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

35.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

36 Infant Hb level at 3‐6 months

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

36.1 High‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

36.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

37 Infant iron indices (ferritin) at 3 to 6 months.

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

37.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

37.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

38 Exclusive breastfeeding at discharge from hospital

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

38.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

38.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

39 Neurodevelopmental, cognitive or developmental outcomes assessed after age 18 months.

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

39.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

39.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

40 Return to hospital as in‐ or outpatient because of bleeding (not pre‐specified) Show forest plot

2

2941

Risk Ratio (M‐H, Random, 95% CI)

2.21 [1.29, 3.79]

40.1 High‐income setting

2

2941

Risk Ratio (M‐H, Random, 95% CI)

2.21 [1.29, 3.79]

40.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

41 Postnatal maternal mean Hb (outcome not pre‐specified) Show forest plot

2

2683

Mean Difference (IV, Random, 95% CI)

0.5 [0.41, 0.59]

41.1 High‐income setting 

2

2683

Mean Difference (IV, Random, 95% CI)

0.5 [0.41, 0.59]

41.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 2. Active versus expectant management of 3rd stage of labour (women at low risk)
Comparison 3. Active versus mixed management of 3rd stage (early uterotonic, delayed cord clamping, CCT)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Severe primary PPH at time of birth (clinically estimated or measured blood loss ≥ 1000 mL)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.1 High‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2 Very severe primary PPH at time of birth (clinically estimated or measured blood loss ≥ 2500 mL)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.1 High‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3 Maternal mortality

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4 Maternal Hb < 9 g/dL at 24‐72 hr

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.1 High‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5 Admission to neonatal special/intensive care

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6 Neonatal jaundice requiring phototherapy or exchange transfusion

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7 Neonatal polycythaemia treated with dilutional exchange transfusion

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 3. Active versus mixed management of 3rd stage (early uterotonic, delayed cord clamping, CCT)
Comparison 4. Active versus mixed management of 3rd stage (delayed uterotonic, delayed cord clamping, CCT)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Severe primary PPH at time of birth (clinically estimated or measured blood loss ≥ 1000 mL)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.1 High‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2 Very severe primary PPH at time of birth (clinically estimated or measured blood loss ≥ 2500 mL)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.1 High‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3 Maternal mortality

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4 Maternal Hb < 9 g/dL at 24‐72 hr

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.1 High‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5 Admission to neonatal special/intensive care

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6 Neonatal jaundice requiring phototherapy or exchange transfusion

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7 Neonatal polycythaemia treated with dilutional exchange transfusion

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 4. Active versus mixed management of 3rd stage (delayed uterotonic, delayed cord clamping, CCT)
Comparison 5. Active versus mixed management of 3rd stage (delayed uterotonic, delayed cord clamping, no CCT)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Severe primary PPH at time of birth (clinically estimated or measured blood loss ≥ 1000 mL)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.1 High‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2 Very severe primary PPH at time of birth (clinically estimated or measured blood loss ≥ 2500 mL)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.1 High‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3 Maternal mortality

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4 Maternal Hb < 9 g/dL at 24‐72 hr

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.1 High‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5 Admission to neonatal special/intensive care

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6 Neonatal jaundice requiring phototherapy or exchange transfusion

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7 Neonatal polycythaemia treated with dilutional exchange transfusion

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 5. Active versus mixed management of 3rd stage (delayed uterotonic, delayed cord clamping, no CCT)
Comparison 6. Active management with prophylactic uterotonic given before birth versus active management with uterotonic given after birth

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Severe primary PPH at time of birth (clinically estimated or measured blood loss ≥ 1000 mL)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.1 High‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2 Very severe primary PPH at time of birth (clinically estimated or measured blood loss ≥ 2500 mL)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.1 High‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3 Maternal mortality

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4 Maternal Hb < 9 g/dL at 24‐72 hr

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.1 High‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5 Admission to neonatal special/intensive care

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6 Neonatal jaundice requiring phototherapy or exchange transfusion

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7 Neonatal polycythaemia treated with dilutional exchange transfusion

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 6. Active management with prophylactic uterotonic given before birth versus active management with uterotonic given after birth
Comparison 7. Mixed management (early uterotonic, delayed cord clamping, CCT) versus expectant management

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Severe primary PPH at time of birth (clinically estimated or measured blood loss ≥ 1000 mL)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.1 High‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2 Very severe primary PPH at time of birth (clinically estimated or measured blood loss ≥ 2500 mL)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.1 High‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3 Maternal mortality

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4 Maternal Hb < 9 g/dL at 24‐72 hr

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.1 High‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5 Admission to neonatal special/intensive care

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6 Neonatal jaundice requiring phototherapy or exchange transfusion

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7 Neonatal polycythaemia treated with dilutional exchange transfusion

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 7. Mixed management (early uterotonic, delayed cord clamping, CCT) versus expectant management
Comparison 8. Mixed management (delayed uterotonic, delayed cord clamping, CCT) versus expectant management

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Severe primary PPH at time of birth (clinically estimated or measured blood loss ≥ 1000 mL)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.1 High‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2 Very severe primary PPH at time of birth (clinically estimated or measured blood loss ≥ 2500 mL)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.1 High‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3 Maternal mortality

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4 Maternal Hb < 9 g/dL at 24‐72 hr

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.1 High‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5 Admission to neonatal special/intensive care

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6 Neonatal jaundice requiring phototherapy or exchange transfusion

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7 Neonatal polycythaemia treated with dilutional exchange transfusion

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 8. Mixed management (delayed uterotonic, delayed cord clamping, CCT) versus expectant management
Comparison 9. Mixed management (delayed uterotonic, delayed cord clamping, no CCT) versus expectant management

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Severe primary PPH at time of birth (clinically estimated or measured blood loss ≥ 1000 mL)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.1 High‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2 Very severe primary PPH at time of birth (clinically estimated or measured blood loss ≥ 2500 mL)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.1 High‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3 Maternal mortality

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4 Maternal Hb < 9 g/dL at 24‐72 hr

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.1 High‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5 Admission to neonatal special/intensive care

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6 Neonatal jaundice requiring phototherapy or exchange transfusion

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7 Neonatal polycythaemia treated with dilutional exchange transfusion

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 9. Mixed management (delayed uterotonic, delayed cord clamping, no CCT) versus expectant management
Comparison 10. Active versus mixed management (uterotonic after placental delivery, immediate cord clamping and no CCT)  

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Severe primary PPH at time of birth (clinically estimated or measured blood loss ≥ 1000 mL) Show forest plot

1

1648

Risk Ratio (M‐H, Random, 95% CI)

0.23 [0.09, 0.55]

1.1 High‐income setting

1

1648

Risk Ratio (M‐H, Random, 95% CI)

0.23 [0.09, 0.55]

1.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2 Very severe primary PPH at time of birth (clinically estimated or measured blood loss ≥ 2500 mL)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.1 High‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3 Maternal mortality

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4 Maternal Hb < 9 g/dL at 24‐72 hr

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.1 High‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5 Admission to neonatal special/intensive care

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6 Neonatal jaundice requiring phototherapy or exchange transfusion

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7 Neonatal polycythaemia treated with dilutional exchange transfusion

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8 Severe primary PPH after placental delivery and up to 24 hours (clinically estimated or measured blood loss ≥ 1000 mL)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

9 Severe primary PPH at time of birth and up to 24 hours (clinically estimated or measured blood loss ≥1000 mL)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

9.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

9.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

10 Primary blood loss ≥ 500 mL at time of birth (clinically estimated or measured) Show forest plot

1

1648

Risk Ratio (M‐H, Random, 95% CI)

0.53 [0.38, 0.74]

10.1 High‐income setting

1

1648

Risk Ratio (M‐H, Random, 95% CI)

0.53 [0.38, 0.74]

10.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

11 Primary blood loss ≥ 500 mL after delivery of placenta and up to 24 hours (clinically estimated or measured)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

11.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

11.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

12 Primary blood loss ≥ 500 mL at time of birth and up to 24 hours (clinically estimated or measured)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

12.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

12.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

13 Mean maternal blood loss (mL) at time of birth (clinically estimated or measured)

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

13.1 High‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

13.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

14 Mean maternal blood loss (mL) after delivery of placenta and up to 24 hours (clinically estimated or measured)

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

14.1 High‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

14.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

15 Mean maternal blood loss (mL) at time of birth and up to 24 hours (clinically estimated or measured)

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

15.1 High‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

15.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

16 Maternal blood transfusion Show forest plot

1

1648

Risk Ratio (M‐H, Random, 95% CI)

0.25 [0.03, 2.22]

16.1 High‐income setting

1

1648

Risk Ratio (M‐H, Random, 95% CI)

0.25 [0.03, 2.22]

16.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

17 Clinical signs of severe blood loss Show forest plot

1

1648

Risk Ratio (M‐H, Random, 95% CI)

0.25 [0.05, 1.17]

17.1 High‐income setting 

1

1648

Risk Ratio (M‐H, Random, 95% CI)

0.25 [0.05, 1.17]

17.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

18 Therapeutic uterotonics during third stage and/or within 24 hours Show forest plot

1

1648

Risk Ratio (M‐H, Random, 95% CI)

0.45 [0.26, 0.77]

18.1 High‐income setting

1

1648

Risk Ratio (M‐H, Random, 95% CI)

0.45 [0.26, 0.77]

18.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

19 Mean length of third stage Show forest plot

1

1648

Mean Difference (IV, Random, 95% CI)

‐10.0 [‐10.24, ‐9.76]

19.1 High‐income setting

1

1648

Mean Difference (IV, Random, 95% CI)

‐10.0 [‐10.24, ‐9.76]

19.2 Low‐income setting

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

20 Manual removal of placenta as defined by authors

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

20.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

20.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

21 Postnatal diastolic blood pressure > 90 mmHg between birth of baby and discharge from the labour ward.

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

21.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

21.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

22 Postnatal vomiting between birth of baby and discharge from the labour ward

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

22.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

22.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

23 Any analgesia between birth of the baby and discharge from labour ward

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

23.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

23.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

24 Women's assessment of pain during third stage as reported by authors

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

24.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

24.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

25 Secondary blood loss/any vaginal bleeding needing treatment (after 24 hours and up to 6 weeks)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

25.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

25.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

26 Amount of lochia either estimated or measured after 24 hours and up to discharge from hospital

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

26.1 High‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

26.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

27 Surgical evacuation of retained products of conception

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

27.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

27.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

28 Afterpains ‐ abdominal pain associated with the contracting uterus in the postpartum period

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

28.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

28.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

29 Apgar score < 7 at 5 minutes

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

29.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

29.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

30 Birthweight

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

30.1 High‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

30.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

31 Neonatal encephalopathy assessed using Sarnat staging (Sarnat 1976; Table 1)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

31.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

31.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

32 Neonatal mortality

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

32.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

32.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

33 Intraventricular haemorrhage ‐ Papille grade III/IV ‐ (for infants born before 34 weeks' gestation only).

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

33.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

33.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

34 Number of infants who received a red blood cell transfusion.

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

34.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

34.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

35 Infant Hb level at 24 to 72 hours

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

35.1 High‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

35.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

36 Infant Hb level at 3‐6 months

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

36.1 High‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

36.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

37 Infant iron indices (ferritin) at 3 to 6 months.

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

37.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

37.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

38 Exclusive breastfeeding at discharge from hospital

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

38.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

38.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

39 Neurodevelopmental, cognitive or developmental outcomes assessed after age 18 months.

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

39.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

39.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

40 Return to hospital as in‐ or outpatient because of bleeding (not pre‐specified)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

40.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

40.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

41 Postnatal maternal mean Hb (outcome not pre‐specified)

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

41.1 High‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

41.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 10. Active versus mixed management (uterotonic after placental delivery, immediate cord clamping and no CCT)  
Comparison 11. Active versus mixed management (no routine uterotonic, early cord clamping, no CCT)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Severe primary PPH at time of birth (clinically estimated or measured blood loss ≥ 1000 mL) Show forest plot

1

1621

Risk Ratio (M‐H, Random, 95% CI)

0.78 [0.48, 1.24]

1.1 High‐income setting

1

1621

Risk Ratio (M‐H, Random, 95% CI)

0.78 [0.48, 1.24]

1.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2 Very severe primary PPH at time of birth (clinically estimated or measured blood loss ≥ 2500 mL)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.1 High‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3 Maternal mortality

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4 Maternal Hb < 9 g/dL at 24‐72 hr Show forest plot

1

1631

Risk Ratio (M‐H, Random, 95% CI)

1.23 [0.75, 2.01]

4.1 High‐income setting

1

1631

Risk Ratio (M‐H, Random, 95% CI)

1.23 [0.75, 2.01]

4.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5 Admission to neonatal special/intensive care

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6 Neonatal jaundice requiring phototherapy or exchange transfusion

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7 Neonatal polycythaemia treated with dilutional exchange transfusion

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8 Severe primary PPH after placental delivery and up to 24 hours (clinically estimated or measured blood loss ≥ 1000 mL)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8.1 High‐income setting  

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8.2 Low‐income setting  

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

9 Severe primary PPH at time of birth and up to 24 hours (clinically estimated or measured blood loss ≥1000 mL)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

9.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

9.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

10 Primary blood loss ≥ 500 mL at time of birth (clinically estimated or measured) Show forest plot

1

1621

Risk Ratio (M‐H, Random, 95% CI)

0.51 [0.40, 0.66]

10.1 High‐income setting 

1

1621

Risk Ratio (M‐H, Random, 95% CI)

0.51 [0.40, 0.66]

10.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

11 Primary blood loss ≥ 500 mL after delivery of placenta and up to 24 hours (clinically estimated or measured)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

11.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

11.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

12 Primary blood loss ≥ 500 mL at time of birth and up to 24 hours (clinically estimated or measured)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

12.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

12.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

13 Mean maternal blood loss (mL) at time of birth (clinically estimated or measured) Show forest plot

1

1621

Mean Difference (IV, Random, 95% CI)

‐94.0 [‐126.57, ‐61.43]

13.1 High‐income setting

1

1621

Mean Difference (IV, Random, 95% CI)

‐94.0 [‐126.57, ‐61.43]

13.2 Low‐income setting

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

14 Mean maternal blood loss (mL) after delivery of placenta and up to 24 hours (clinically estimated or measured)

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

14.1 High‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

14.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

15 Mean maternal blood loss (mL) at time of birth and up to 24 hours (clinically estimated or measured)

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

15.1 High‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

15.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

16 Maternal blood transfusion Show forest plot

1

1631

Risk Ratio (M‐H, Random, 95% CI)

0.79 [0.43, 1.46]

16.1 High‐income setting 

1

1631

Risk Ratio (M‐H, Random, 95% CI)

0.79 [0.43, 1.46]

16.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

17 Clinical signs of severe blood loss

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

17.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

17.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

18 Therapeutic uterotonics during third stage and/or within 24 hours Show forest plot

1

1631

Risk Ratio (M‐H, Random, 95% CI)

0.39 [0.33, 0.48]

18.1 High‐income setting 

1

1631

Risk Ratio (M‐H, Random, 95% CI)

0.39 [0.33, 0.48]

18.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

19 Mean length of third stage Show forest plot

1

1631

Mean Difference (IV, Random, 95% CI)

‐1.60 [‐3.08, ‐0.12]

19.1 High‐income setting 

1

1631

Mean Difference (IV, Random, 95% CI)

‐1.60 [‐3.08, ‐0.12]

19.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

20 Manual removal of placenta as defined by authors Show forest plot

1

1631

Risk Ratio (M‐H, Random, 95% CI)

1.25 [0.71, 2.21]

20.1 High‐income setting 

1

1631

Risk Ratio (M‐H, Random, 95% CI)

1.25 [0.71, 2.21]

20.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

21 Postnatal diastolic blood pressure > 90 mmHg between birth of baby and discharge from the labour ward.

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

21.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

21.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

22 Postnatal vomiting between birth of baby and discharge from the labour ward

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

22.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

22.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

23 Any analgesia between birth of the baby and discharge from labour ward

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

23.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

23.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

24 Women's assessment of pain during third stage as reported by authors

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

24.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

24.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

25 Secondary blood loss/any vaginal bleeding needing treatment (after 24 hours and up to 6 weeks)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

25.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

25.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

26 Amount of lochia either estimated or measured after 24 hours and up to discharge from hospital

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

26.1 High‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

26.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

27 Surgical evacuation of retained products of conception

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

27.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

27.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

28 Not prespecified: afterpains at 2 hours after birth (id 20458) Show forest plot

1

1425

Mean Difference (IV, Fixed, 95% CI)

‐2.80 [‐4.62, ‐0.98]

28.1 High‐income setting 

1

1425

Mean Difference (IV, Fixed, 95% CI)

‐2.80 [‐4.62, ‐0.98]

28.2 Low‐income setting 

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

29 Not pre‐specified: afterpains the day after birth (id 20458) Show forest plot

1

1336

Mean Difference (IV, Fixed, 95% CI)

‐3.0 [‐5.33, ‐0.67]

29.1 High‐income setting

1

1336

Mean Difference (IV, Fixed, 95% CI)

‐3.0 [‐5.33, ‐0.67]

29.2 Low‐income setting

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

30 Apgar score < 7 at 5 minutes

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

30.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

30.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

31 Birthweight Show forest plot

1

1631

Mean Difference (IV, Random, 95% CI)

15.0 [‐28.88, 58.88]

31.1 High‐income setting 

1

1631

Mean Difference (IV, Random, 95% CI)

15.0 [‐28.88, 58.88]

31.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

32 Neonatal encephalopathy assessed using Sarnat staging (Sarnat 1976; Table 1)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

32.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

32.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

33 Neonatal mortality

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

33.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

33.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

34 Intraventricular haemorrhage ‐ Papille grade III/IV ‐ (for infants born before 34 weeks' gestation only).

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

34.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

34.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

35 Number of infants who received a red blood cell transfusion.

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

35.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

35.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

36 Infant Hb level at 24 to 72 hours

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

36.1 High‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

36.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

37 Infant Hb level at 3‐6 months

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

37.1 High‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

37.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

38 Infant iron indices (ferritin) at 3 to 6 months.

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

38.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

38.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

39 Exclusive breastfeeding at discharge from hospital

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

39.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

39.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

40 Neurodevelopmental, cognitive or developmental outcomes assessed after age 18 months.

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

40.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

40.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

41 Return to hospital as in‐ or outpatient because of bleeding (not pre‐specified)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

42 Postnatal maternal mean Hb (outcome not pre‐specified) Show forest plot

1

1631

Mean Difference (IV, Random, 95% CI)

0.28 [0.14, 0.42]

42.1 High‐income setting 

1

1631

Mean Difference (IV, Random, 95% CI)

0.28 [0.14, 0.42]

42.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

43 Severe primary PPH after placental delivery and up to 2 hours (clinically estimated or measured blood loss ≥ 1000 mL) ‐ not pre‐specified Show forest plot

1

1621

Risk Ratio (M‐H, Random, 95% CI)

0.54 [0.39, 0.74]

43.1 High‐income setting 

1

1621

Risk Ratio (M‐H, Random, 95% CI)

0.54 [0.39, 0.74]

43.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

44 Severe primary PPH at time of birth and up to 2 hours (clinically estimated or measured blood loss ≥1000 mL) ‐ not pre‐specified Show forest plot

1

1621

Risk Ratio (M‐H, Random, 95% CI)

0.60 [0.47, 0.78]

44.1 High‐income setting 

1

1621

Risk Ratio (M‐H, Random, 95% CI)

0.60 [0.47, 0.78]

44.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

45 Mean blood loss (mL) (clinically estimated or measured at birth and up to 2 hours (not pre‐specified) Show forest plot

1

1621

Mean Difference (IV, Random, 95% CI)

‐49.0 [‐75.52, ‐22.48]

45.1 High‐income setting 

1

1621

Mean Difference (IV, Random, 95% CI)

‐49.0 [‐75.52, ‐22.48]

45.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 11. Active versus mixed management (no routine uterotonic, early cord clamping, no CCT)
Comparison 12. Active versus mixed management (no routine uterotonic, early cord clamping, CCT)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Severe primary PPH at time of birth (clinically estimated or measured blood loss ≥ 1000 mL)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.1 High‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2 Very severe primary PPH at time of birth (clinically estimated or measured blood loss ≥ 2500 mL)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.1 High‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.2 Low‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3 Maternal mortality

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4 Maternal Hb < 9 g/dL at 24‐72 hr Show forest plot

1

130

Risk Ratio (M‐H, Random, 95% CI)

0.8 [0.34, 1.90]

4.1 High‐income setting

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.2 Low‐income setting

1

130

Risk Ratio (M‐H, Random, 95% CI)

0.8 [0.34, 1.90]

5 Admission to neonatal special/intensive care

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6 Neonatal jaundice requiring phototherapy or exchange transfusion

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7 Neonatal polycythaemia treated with dilutional exchange transfusion

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8 Severe primary PPH after placental delivery and up to 24 hours (clinically estimated or measured blood loss ≥ 1000 mL)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

9 Severe primary PPH at time of birth and up to 24 hours (clinically estimated or measured blood loss ≥1000 mL)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

9.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

9.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

10 Primary blood loss ≥ 500 mL at time of birth (clinically estimated or measured)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

10.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

10.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

11 Primary blood loss ≥ 500 mL after delivery of placenta and up to 24 hours (clinically estimated or measured)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

11.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

11.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

12 Primary blood loss ≥ 500 mL at time of birth and up to 24 hours (clinically estimated or measured)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

12.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

12.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

13 Mean maternal blood loss (mL) at time of birth (clinically estimated or measured)

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

13.1 High‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

13.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

14 Mean maternal blood loss (mL) after delivery of placenta and up to 24 hours (clinically estimated or measured)

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

14.1 High‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

14.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

15 Mean maternal blood loss (mL) at time of birth and up to 24 hours (clinically estimated or measured)

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

15.1 High‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

15.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

16 Maternal blood transfusion

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

16.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

16.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

17 Clinical signs of severe blood loss

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

17.1 High‐income setting  

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

17.2 Low‐income setting  

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

18 Therapeutic uterotonics during third stage and/or within 24 hours

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

18.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

18.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

19 Mean length of third stage Show forest plot

1

130

Mean Difference (IV, Random, 95% CI)

‐8.12 [‐9.72, ‐6.52]

19.1 High‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

19.2 Low‐income setting 

1

130

Mean Difference (IV, Random, 95% CI)

‐8.12 [‐9.72, ‐6.52]

20 Manual removal of placenta as defined by authors Show forest plot

1

130

Risk Ratio (M‐H, Random, 95% CI)

1.0 [0.06, 15.65]

20.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

20.2 Low‐income setting 

1

130

Risk Ratio (M‐H, Random, 95% CI)

1.0 [0.06, 15.65]

21 Postnatal diastolic blood pressure > 90 mmHg between birth of baby and discharge from the labour ward.

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

21.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

21.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

22 Postnatal vomiting between birth of baby and discharge from the labour ward

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

22.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

22.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

23 Any analgesia between birth of the baby and discharge from labour ward

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

23.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

23.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

24 Women's assessment of pain during third stage as reported by authors

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

24.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

24.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

25 Secondary blood loss/any vaginal bleeding needing treatment (after 24 hours and up to 6 weeks)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

25.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

25.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

26 Amount of lochia either estimated or measured after 24 hours and up to discharge from hospital

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

26.1 High‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

26.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

27 Surgical evacuation of retained products of conception

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

27.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

27.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

28 Afterpains ‐ abdominal pain associated with the contracting uterus in the postpartum period

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

28.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

28.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

29 Apgar score < 7 at 5 minutes

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

29.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

29.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

30 Birthweight

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

30.1 High‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

30.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

31 Neonatal encephalopathy assessed using Sarnat staging (Sarnat 1976; Table 1)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

31.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

31.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

32 Neonatal mortality

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

32.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

32.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

33 Intraventricular haemorrhage ‐ Papille grade III/IV ‐ (for infants born before 34 weeks' gestation only).

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

33.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

33.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

34 Number of infants who received a red blood cell transfusion.

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

34.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

34.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

35 Infant Hb level at 24 to 72 hours

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

35.1 High‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

35.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

36 Infant Hb level at 3‐6 months

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

36.1 High‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

36.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

37 Infant iron indices (ferritin) at 3 to 6 months.

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

37.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

37.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

38 Exclusive breastfeeding at discharge from hospital

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

38.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

38.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

39 Neurodevelopmental, cognitive or developmental outcomes assessed after age 18 months.

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

39.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

39.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

40 Return to hospital as in‐ or outpatient because of bleeding (not pre‐specified)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

40.1 High‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

40.2 Low‐income setting 

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

41 Postnatal maternal mean Hb (outcome not pre‐specified)

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

41.1 High‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

41.2 Low‐income setting 

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 12. Active versus mixed management (no routine uterotonic, early cord clamping, CCT)