Techniques for preventing hypotension during spinal anaesthesia for caesarean section

Allan M Cyna; Marion Andrew; Richard S Emmett; Philippa Middleton; Scott W Simmons

doi:10.1002/14651858.CD002251.pub2

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Analysis 1.1

Comparison 1 Crystalloid versus control, Outcome 1 Women with hypotension requiring intervention.

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Analysis 2.1

Comparison 2 Crystalloid: rapid infusion versus slow infusion, Outcome 1 Women with hypotension requiring intervention.

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Analysis 3.1

Comparison 3 Crystalloid: low versus high preload volume, Outcome 1 Women with hypotension requiring intervention.

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Analysis 4.1

Comparison 4 Crystalloid: preload versus rapid coload, Outcome 1 Women with hypotension requiring intervention.

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Analysis 4.2

Comparison 4 Crystalloid: preload versus rapid coload, Outcome 2 Women with nausea.

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Analysis 4.3

Comparison 4 Crystalloid: preload versus rapid coload, Outcome 3 Neonates with acidosis (pH less than 7.2).

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Analysis 4.4

Comparison 4 Crystalloid: preload versus rapid coload, Outcome 4 Apgar less than 8 at 5 minutes.

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Analysis 5.1

Comparison 5 Crystalloid: warm versus cold, Outcome 1 Women with hypotension requiring intervention.

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Analysis 5.2

Comparison 5 Crystalloid: warm versus cold, Outcome 2 Women with nausea and/or vomiting.

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Analysis 6.1

Comparison 6 Crystalloid versus another crystalloid, Outcome 1 Women with hypotension requiring intervention.

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Analysis 6.2

Comparison 6 Crystalloid versus another crystalloid, Outcome 2 Neonates with acidosis.

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Analysis 6.3

Comparison 6 Crystalloid versus another crystalloid, Outcome 3 Neonates with Apgar score less than 7 at 5 minutes.

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Analysis 7.1

Comparison 7 Colloid versus crystalloid, Outcome 1 Women with hypotension requiring intervention.

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Analysis 7.2

Comparison 7 Colloid versus crystalloid, Outcome 2 Women with nausea and/or vomiting.

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Analysis 7.3

Comparison 7 Colloid versus crystalloid, Outcome 3 Women with cardiac dysrhythmia.

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Analysis 7.4

Comparison 7 Colloid versus crystalloid, Outcome 4 Neonates with acidosis (pH less than 7.2).

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Analysis 7.5

Comparison 7 Colloid versus crystalloid, Outcome 5 Neonates: Apgar score.

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Analysis 7.6

Comparison 7 Colloid versus crystalloid, Outcome 6 Women with hypotension requiring intervention.

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Analysis 8.1

Comparison 8 Colloid: different volumes, Outcome 1 Women with hypotension requiring intervention.

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Analysis 9.1

Comparison 9 Colloid + crystalloid versus crystalloid, Outcome 1 Women with hypotension requiring intervention.

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Analysis 9.2

Comparison 9 Colloid + crystalloid versus crystalloid, Outcome 2 Women with nausea and/or vomiting.

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Analysis 9.3

Comparison 9 Colloid + crystalloid versus crystalloid, Outcome 3 Neonates with Apgar score less than 7 at 5 minutes.

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Analysis 10.1

Comparison 10 Colloid + crystalloid versus another colloid + crystalloid, Outcome 1 Women with hypotension requiring intervention.

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Analysis 10.2

Comparison 10 Colloid + crystalloid versus another colloid + crystalloid, Outcome 2 Neonates: Apgar score less than 7.

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Analysis 11.1

Comparison 11 Ephedrine versus control, Outcome 1 Women with hypotension requiring intervention.

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Analysis 11.2

Comparison 11 Ephedrine versus control, Outcome 2 Women with nausea and/or vomiting.

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Analysis 11.4

Comparison 11 Ephedrine versus control, Outcome 4 Women with hypertension requiring intervention.

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Analysis 11.5

Comparison 11 Ephedrine versus control, Outcome 5 Neonates with acidosis (pH less than 7.2).

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Analysis 11.6

Comparison 11 Ephedrine versus control, Outcome 6 Neonates: Apgar score.

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Analysis 12.1

Comparison 12 Ephedrine versus crystalloid, Outcome 1 Women with hypotension requiring intervention.

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Analysis 12.2

Comparison 12 Ephedrine versus crystalloid, Outcome 2 Women with nausea and/or vomiting.

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Analysis 12.3

Comparison 12 Ephedrine versus crystalloid, Outcome 3 Women with impaired consciousness.

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Analysis 12.4

Comparison 12 Ephedrine versus crystalloid, Outcome 4 Women with hypertension requiring intervention.

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Analysis 12.5

Comparison 12 Ephedrine versus crystalloid, Outcome 5 Neonates with acidosis (pH less than 7.2).

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Analysis 12.6

Comparison 12 Ephedrine versus crystalloid, Outcome 6 Neonatal Apgar score.

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Analysis 13.1

Comparison 13 Ephedrine versus ephedrine + crystalloid, Outcome 1 Women with hypotension requiring intervention.

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Analysis 14.1

Comparison 14 Ephedrine + crystalloid versus crystalloid, Outcome 1 Women with hypotension requiring intervention.

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Analysis 14.2

Comparison 14 Ephedrine + crystalloid versus crystalloid, Outcome 2 Women with nausea and/or vomiting.

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Analysis 14.3

Comparison 14 Ephedrine + crystalloid versus crystalloid, Outcome 3 Women with hypertension requiring intervention.

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Analysis 14.4

Comparison 14 Ephedrine + crystalloid versus crystalloid, Outcome 4 Women with cardiac dysrhythmia.

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Analysis 14.5

Comparison 14 Ephedrine + crystalloid versus crystalloid, Outcome 5 Neonates with acidosis (pH less than 7.2).

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Analysis 14.6

Comparison 14 Ephedrine + crystalloid versus crystalloid, Outcome 6 Neonatal Apgar score.

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Analysis 15.1

Comparison 15 Ephedrine + crystalloid versus colloid, Outcome 1 Women with hypotension requiring intervention.

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Analysis 15.2

Comparison 15 Ephedrine + crystalloid versus colloid, Outcome 2 Women with nausea and/or vomiting.

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Analysis 16.1

Comparison 16 Ephedrine + colloid versus colloid, Outcome 1 Women with hypotension requiring intervention.

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Analysis 16.2

Comparison 16 Ephedrine + colloid versus colloid, Outcome 2 Women with nausea and/or vomiting.

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Analysis 17.1

Comparison 17 Ephedrine + colloid versus crystalloid, Outcome 1 Women with hypotension requiring intervention.

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Analysis 17.2

Comparison 17 Ephedrine + colloid versus crystalloid, Outcome 2 Women with nausea and/or vomiting.

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Analysis 18.1

Comparison 18 Ephedrine + colloid versus ephedrine + crystalloid, Outcome 1 Women with hypotension requiring intervention.

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Analysis 18.2

Comparison 18 Ephedrine + colloid versus ephedrine + crystalloid, Outcome 2 Women with nausea and/or vomiting.

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Analysis 19.1

Comparison 19 Ephedrine versus phenylephrine, Outcome 1 Women with hypotension requiring intervention.

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Analysis 19.4

Comparison 19 Ephedrine versus phenylephrine, Outcome 4 Neonates with acidosis (pH less than 7.2).

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Analysis 19.5

Comparison 19 Ephedrine versus phenylephrine, Outcome 5 Neonates with Apgar score less than 8 at 5 minutes.

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Analysis 20.1

Comparison 20 Ephedrine + crystalloid versus phenylephrine + crystalloid, Outcome 1 Women with hypertension requiring intervention.

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Analysis 20.2

Comparison 20 Ephedrine + crystalloid versus phenylephrine + crystalloid, Outcome 2 Women with nausea and/or vomiting.

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Analysis 20.3

Comparison 20 Ephedrine + crystalloid versus phenylephrine + crystalloid, Outcome 3 Women with cardiac dysrhythmia.

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Analysis 20.4

Comparison 20 Ephedrine + crystalloid versus phenylephrine + crystalloid, Outcome 4 Neonatal Apgar score less than 8 at 5 minutes.

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Analysis 21.1

Comparison 21 Ephedrine versus ephedrine + phenylephrine, Outcome 1 Women with hypotension requiring intervention.

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Analysis 21.2

Comparison 21 Ephedrine versus ephedrine + phenylephrine, Outcome 2 Women with nausea.

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Analysis 21.3

Comparison 21 Ephedrine versus ephedrine + phenylephrine, Outcome 3 Neonates with Apgar less than 8 at 5 minutes.

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Analysis 22.1

Comparison 22 Ephedrine versus angiotensin, Outcome 1 Women with hypotension requiring intervention.

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Analysis 22.2

Comparison 22 Ephedrine versus angiotensin, Outcome 2 Women with nausea and/or vomiting.

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Analysis 22.3

Comparison 22 Ephedrine versus angiotensin, Outcome 3 Neonates with acidosis (pH less than 7.2).

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Analysis 23.1

Comparison 23 Ephedrine: different doses, Outcome 1 Women with hypotension requiring intervention.

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Analysis 23.2

Comparison 23 Ephedrine: different doses, Outcome 2 Women with nausea and/or vomiting.

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Analysis 23.3

Comparison 23 Ephedrine: different doses, Outcome 3 Women with hypertension requiring intervention.

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Analysis 23.4

Comparison 23 Ephedrine: different doses, Outcome 4 Neonates with acidosis (pH less than 7.2).

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Analysis 23.5

Comparison 23 Ephedrine: different doses, Outcome 5 Neonatal Apgar score at 5 minutes.

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Analysis 24.1

Comparison 24 Ephedrine: different rates, Outcome 1 Women with hypotension requiring intervention.

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Analysis 24.2

Comparison 24 Ephedrine: different rates, Outcome 2 Women with nausea and/or vomiting.

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Analysis 24.3

Comparison 24 Ephedrine: different rates, Outcome 3 Women with hypertension requiring intervention.

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Analysis 24.4

Comparison 24 Ephedrine: different rates, Outcome 4 Neonates with acidosis (pH less than 7.2).

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Analysis 24.5

Comparison 24 Ephedrine: different rates, Outcome 5 Neonatal Apgar score at 5 min.

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Analysis 25.1

Comparison 25 Ephedrine + crystalloid: different doses or rates, Outcome 1 Women with hypotension requiring intervention.

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Analysis 25.2

Comparison 25 Ephedrine + crystalloid: different doses or rates, Outcome 2 Women with nausea and/or vomiting.

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Analysis 25.3

Comparison 25 Ephedrine + crystalloid: different doses or rates, Outcome 3 Women with hypertension requiring intervention.

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Analysis 25.4

Comparison 25 Ephedrine + crystalloid: different doses or rates, Outcome 4 Women with cardiac dysrhythmia.

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Analysis 25.5

Comparison 25 Ephedrine + crystalloid: different doses or rates, Outcome 5 Neonates with acidosis (pH less than 7.2).

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Analysis 25.6

Comparison 25 Ephedrine + crystalloid: different doses or rates, Outcome 6 Neonatal Apgar score at 5 minutes.

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Analysis 26.1

Comparison 26 Ephedrine + colloid: different doses, Outcome 1 Women with hypotension requiring intervention.

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Analysis 26.2

Comparison 26 Ephedrine + colloid: different doses, Outcome 2 Women with nausea and/or vomiting.

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Analysis 27.1

Comparison 27 Ephedrine + colloid + crystalloid versus colloid + crystalloid, Outcome 1 Women with hypotension requiring intervention.

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Analysis 27.2

Comparison 27 Ephedrine + colloid + crystalloid versus colloid + crystalloid, Outcome 2 Nausea and vomiting.

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Analysis 27.3

Comparison 27 Ephedrine + colloid + crystalloid versus colloid + crystalloid, Outcome 3 Neonates with acidosis (pH less than 7.2).

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Analysis 27.4

Comparison 27 Ephedrine + colloid + crystalloid versus colloid + crystalloid, Outcome 4 Neonatal Apgar score.

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Analysis 28.1

Comparison 28 Phenylephrine versus control, Outcome 1 Women with hypotension requiring intervention.

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Analysis 28.2

Comparison 28 Phenylephrine versus control, Outcome 2 Women with nausea and/or vomiting.

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Analysis 28.3

Comparison 28 Phenylephrine versus control, Outcome 3 Women with cardiac dysrhythmia.

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Analysis 28.4

Comparison 28 Phenylephrine versus control, Outcome 4 Neonates with acidosis (pH less than 7.2).

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Analysis 28.5

Comparison 28 Phenylephrine versus control, Outcome 5 Neonates with Apgar less than 7 at 5 minutes.

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Analysis 29.1

Comparison 29 Phenylephrine + crystalloid versus crystalloid, Outcome 1 Women with hypotension requiring intervention.

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Analysis 29.2

Comparison 29 Phenylephrine + crystalloid versus crystalloid, Outcome 2 Women with cardiac dysrhythmia.

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Analysis 29.3

Comparison 29 Phenylephrine + crystalloid versus crystalloid, Outcome 3 Neonates with Apgar less than 8 at 5 minutes.

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Analysis 30.1

Comparison 30 Phenylephrine + crystalloid: different doses, Outcome 1 Women with hypotension requiring intervention.

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Analysis 30.2

Comparison 30 Phenylephrine + crystalloid: different doses, Outcome 2 Women with cardiac dysrhythmia.

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Analysis 30.3

Comparison 30 Phenylephrine + crystalloid: different doses, Outcome 3 Neonatal Apgar score less than 8 at 5 minutes.

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Analysis 31.1

Comparison 31 Angiotensin versus control, Outcome 1 Women with hypotension requiring intervention.

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Analysis 31.2

Comparison 31 Angiotensin versus control, Outcome 2 Women with nausea and/or vomiting.

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Analysis 31.3

Comparison 31 Angiotensin versus control, Outcome 3 Neonates with acidosis (pH less than 7.2).

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Analysis 32.1

Comparison 32 Dopamine + crystalloid versus crystalloid, Outcome 1 Women with hypertension requiring intervention.

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Analysis 32.2

Comparison 32 Dopamine + crystalloid versus crystalloid, Outcome 2 Neonatal Apgar score less than 8 at 5 minutes.

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Analysis 33.1

Comparison 33 Glycopyrrolate + crystalloid versus crystalloid, Outcome 1 Women with hypotension requiring intervention.

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Analysis 33.2

Comparison 33 Glycopyrrolate + crystalloid versus crystalloid, Outcome 2 Women with nausea and/or vomiting.

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Analysis 33.3

Comparison 33 Glycopyrrolate + crystalloid versus crystalloid, Outcome 3 Women with cardiac dysrhythmia requiring intervention.

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Analysis 33.4

Comparison 33 Glycopyrrolate + crystalloid versus crystalloid, Outcome 4 Neonates with Apgar score less than 8 at 5 minutes.

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Analysis 33.5

Comparison 33 Glycopyrrolate + crystalloid versus crystalloid, Outcome 5 Neonates admitted to neonatal intensive care unit.

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Analysis 34.1

Comparison 34 Glycopyrrolate versus ephedrine, Outcome 1 Women with hypotension requiring intervention.

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Analysis 34.2

Comparison 34 Glycopyrrolate versus ephedrine, Outcome 2 Women with nausea and/or vomiting.

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Analysis 34.3

Comparison 34 Glycopyrrolate versus ephedrine, Outcome 3 Women with cardiac dysrhythmia requiring intervention.

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Analysis 34.4

Comparison 34 Glycopyrrolate versus ephedrine, Outcome 4 Neonates admitted to neonatal intensive care unit.

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Analysis 35.1

Comparison 35 Lower limb compression versus control, Outcome 1 Women with hypotension requiring intervention.

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Analysis 35.2

Comparison 35 Lower limb compression versus control, Outcome 2 Women with nausea and/or vomiting.

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Analysis 35.3

Comparison 35 Lower limb compression versus control, Outcome 3 Neonates with Apgar score less than 8 at 5 minutes.

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Analysis 36.1

Comparison 36 Hip flexion versus legs straight, Outcome 1 Neonatal Apgar score less than 7 at 5 minutes.

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Analysis 37.1

Comparison 37 Leg elevation versus control, Outcome 1 Women with hypotension requiring intervention.

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Analysis 38.1

Comparison 38 Lateral versus supine wedged position, Outcome 1 Women with hypotension requiring intervention.

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Analysis 38.2

Comparison 38 Lateral versus supine wedged position, Outcome 2 Women with cardiac dysrhythmia requiring intervention.

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Analysis 38.3

Comparison 38 Lateral versus supine wedged position, Outcome 3 Neonates admitted to neonatal intensive care unit.

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Analysis 39.1

Comparison 39 Lateral recumbent versus sitting, Outcome 1 Women with hypotension requiring intervention.

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Analysis 39.2

Comparison 39 Lateral recumbent versus sitting, Outcome 2 Women with nausea and/or vomiting.

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Analysis 40.1

Comparison 40 Left lateral versus right lateral, Outcome 1 Nausea and vomiting.

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Analysis 41.1

Comparison 41 Left lateral versus left lateral tilt, Outcome 1 Women with hypotension requiring intervention.

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Analysis 41.2

Comparison 41 Left lateral versus left lateral tilt, Outcome 2 Women with nausea and/or vomiting.

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Analysis 41.3

Comparison 41 Left lateral versus left lateral tilt, Outcome 3 Women with cardiac dysrhythmia requiring intervention.

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Analysis 42.1

Comparison 42 Crawford's wedge versus manual uterine displacement, Outcome 1 Women with hypotension requiring intervention.

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Analysis 42.2

Comparison 42 Crawford's wedge versus manual uterine displacement, Outcome 2 Neonates with Apgar score less than 8 at 5 minutes.

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Analysis 43.1

Comparison 43 Oxford position versus right lateral, Outcome 1 Women with hypotension requiring intervention.

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Analysis 43.2

Comparison 43 Oxford position versus right lateral, Outcome 2 Women with nausea and/or vomiting.

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Analysis 44.1

Comparison 44 Oxford position versus sitting, Outcome 1 Women with hypotension requiring treatment.

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Analysis 44.2

Comparison 44 Oxford position versus sitting, Outcome 2 Women with nausea and/or vomiting.

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Analysis 45.1

Comparison 45 Supine versus sitting, Outcome 1 Women with hypotension requiring intervention.

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Analysis 45.2

Comparison 45 Supine versus sitting, Outcome 2 Women with nausea and/or vomiting.

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Analysis 45.3

Comparison 45 Supine versus sitting, Outcome 3 Neonates with acidosis (pH less than 7.2).

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Analysis 45.4

Comparison 45 Supine versus sitting, Outcome 4 Neonates with Apgar less than 7 at 5 minutes.

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Analysis 46.1

Comparison 46 Delayed versus immediate recumbence, Outcome 1 Women with nausea and/or vomiting.

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Analysis 47.1

Comparison 47 Head‐up tilt versus control, Outcome 1 Women with hypotension requiring intervention.

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Analysis 47.2

Comparison 47 Head‐up tilt versus control, Outcome 2 Neonates with Apgar score less than 8 at 5 minutes.

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Analysis 48.1

Comparison 48 Acupressure versus placebo, Outcome 1 Women with hypotension requiring intervention.

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Analysis 48.2

Comparison 48 Acupressure versus placebo, Outcome 2 Women with nausea and/or vomiting.

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Analysis 48.3

Comparison 48 Acupressure versus placebo, Outcome 3 Neonates with Apgar less than 7 at 5 minutes.

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Analysis 49.1

Comparison 49 Acupressure versus metoclopramide, Outcome 1 Women with hypotension requiring intervention.

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Analysis 49.2

Comparison 49 Acupressure versus metoclopramide, Outcome 2 Women with nausea and/or vomiting.

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Analysis 49.3

Comparison 49 Acupressure versus metoclopramide, Outcome 3 Neonates with Apgar less than 7 at 5 minutes.

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Table 1. Hypotension definitions (mmHg or % fall)

Studies	SAP < 80	SAP < 90	SAP < 100	SAP > 10% fall	SAP > 20% fall	SAP > 30% fall	MAP > 20% fall	MAP > 25% fall	S/MAP > 10 mmHg fall
Ueyama 1992	X
Loke 2002; Mathru 1980; Yorozu 2002		X
Pouta 1996		X (or)			X
Karinen 1995; Sood 1996; van Bogaert 2000		X (and)			X
French 1999; Grubb 2004; Loughrey 2002; Young 1996		X (or)				X
Dahlgren 2005; James 1973; Loo 2002; Miyabe 1997; Vercauteren 2000			X
Fabrizi 1998			X (and)	X
Amaro 1998; Jorgensen 1996; Law 2003; Loughrey 2005; Madi‐Jebara 2004; Miller 2000; Rees 2002; Stein 1997; Ueyama 2002; Ure 1999; Wilson 1999; Yentis 2000			X (or)		X
Bhagwanjee 1990; Ngan Kee 2000; Riley 1995; Rout 1992; Rout 1993a; Rout 1993b; Siddik 2000; Sutherland 2001; Ueyama 1999			X (and)		X
Inglis 1995; Jorgensen 2000; Kohler 2002; Webb 1998; Yun 1998			X (or)			X
Cardoso 2004a; Yokoyama 1997				X
Carvalho 1999a; Carvalho 1999b; Carvalho 2000; Chan 1997; Dyer 2004; Hall 1994; Hartley 2001; King 1998; Mendonca 2003; Ngan Kee 2004b; Ozkan 2004; Perumal 2004; Rucklidge 2002; Russell 2002; Selvan 2004; Tercanli 2005; Torres unpub; Turkoz 2002; Wilson 1998					X
Lin 1999; Morgan 2000; Ramin 1994						X
Adsumelli 2003; Tsen 2000							X
Ayorinde 2001; Gomaa 2003								X
Alahuhta 1992 (SAP); Olsen 1994 (MAP)									X

Table 1. Hypotension definitions (mmHg or % fall)

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Comparison 1. Crystalloid versus control

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	1	140	Risk Ratio (M‐H, Random, 95% CI)	0.78 [0.60, 1.00]

1.1 Preload versus no preload	1	140	Risk Ratio (M‐H, Random, 95% CI)	0.78 [0.60, 1.00]

Comparison 1. Crystalloid versus control

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Comparison 2. Crystalloid: rapid infusion versus slow infusion

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	1	20	Risk Ratio (M‐H, Random, 95% CI)	0.86 [0.45, 1.64]

Comparison 2. Crystalloid: rapid infusion versus slow infusion

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Comparison 3. Crystalloid: low versus high preload volume

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	1	22	Risk Ratio (M‐H, Random, 95% CI)	2.33 [0.81, 6.76]

Comparison 3. Crystalloid: low versus high preload volume

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Comparison 4. Crystalloid: preload versus rapid coload

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 Hypotension after spinal and before birth	1	50	Risk Ratio (M‐H, Random, 95% CI)	1.78 [0.98, 3.24]
1.2 Hypotension any time after spinal	1	50	Risk Ratio (M‐H, Random, 95% CI)	1.4 [0.97, 2.01]
2 Women with nausea Show forest plot	1	50	Risk Ratio (M‐H, Random, 95% CI)	1.0 [0.15, 6.55]

3 Neonates with acidosis (pH less than 7.2) Show forest plot	1	50	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

4 Apgar less than 8 at 5 minutes Show forest plot	1	50	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 4. Crystalloid: preload versus rapid coload

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Comparison 5. Crystalloid: warm versus cold

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 All women	1	113	Risk Ratio (M‐H, Random, 95% CI)	1.03 [0.65, 1.62]
1.2 Women with hypotension more than 2 minutes	1	113	Risk Ratio (M‐H, Random, 95% CI)	1.26 [0.51, 3.16]
2 Women with nausea and/or vomiting Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 Nausea	1	113	Risk Ratio (M‐H, Random, 95% CI)	1.64 [0.97, 2.76]
2.2 Vomiting	1	113	Risk Ratio (M‐H, Random, 95% CI)	2.95 [0.12, 70.87]

Comparison 5. Crystalloid: warm versus cold

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Comparison 6. Crystalloid versus another crystalloid

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 Dextrose or saline versus saline	1	120	Risk Ratio (M‐H, Random, 95% CI)	0.88 [0.68, 1.14]
1.2 Glucose versus saline	1	70	Risk Ratio (M‐H, Random, 95% CI)	1.05 [0.74, 1.48]
2 Neonates with acidosis Show forest plot	1	120	Risk Ratio (M‐H, Random, 95% CI)	1.2 [0.39, 3.72]

3 Neonates with Apgar score less than 7 at 5 minutes Show forest plot	1	120	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 6. Crystalloid versus another crystalloid

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Comparison 7. Colloid versus crystalloid

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	11		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 Any hypotension	11	698	Risk Ratio (M‐H, Random, 95% CI)	0.70 [0.51, 0.96]
1.2 Clinically significant hypotension	2	159	Risk Ratio (M‐H, Random, 95% CI)	0.72 [0.35, 1.49]
1.3 Severe hypotension	1	109	Risk Ratio (M‐H, Random, 95% CI)	0.16 [0.04, 0.67]
2 Women with nausea and/or vomiting Show forest plot	4		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 Nausea and/or vomiting	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.4 [0.15, 1.07]
2.2 Nausea	3	160	Risk Ratio (M‐H, Random, 95% CI)	1.43 [0.87, 2.35]
2.3 Vomiting	2	100	Risk Ratio (M‐H, Random, 95% CI)	1.5 [0.48, 4.68]
3 Women with cardiac dysrhythmia Show forest plot	1	26	Risk Ratio (M‐H, Random, 95% CI)	3.00 [0.13, 67.51]

4 Neonates with acidosis (pH less than 7.2) Show forest plot	1	160	Risk Ratio (M‐H, Random, 95% CI)	0.20 [0.01, 4.10]

5 Neonates: Apgar score Show forest plot	4		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

5.1 Less than 7 at 5 minutes	1	67	Risk Ratio (M‐H, Random, 95% CI)	0.16 [0.01, 2.90]
5.2 Less than 8 at 5 minutes	3	209	Risk Ratio (M‐H, Random, 95% CI)	0.24 [0.03, 2.05]
6 Women with hypotension requiring intervention Show forest plot	10		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

6.1 Any hypotension	9	522	Risk Ratio (M‐H, Random, 95% CI)	0.63 [0.35, 1.15]
6.2 Clinically significant hypotension	2	159	Risk Ratio (M‐H, Random, 95% CI)	0.72 [0.35, 1.49]
6.3 Severe hypotension	1	109	Risk Ratio (M‐H, Random, 95% CI)	0.16 [0.04, 0.67]

Comparison 7. Colloid versus crystalloid

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Comparison 8. Colloid: different volumes

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	2	64	Risk Ratio (M‐H, Random, 95% CI)	1.05 [0.25, 4.44]

Comparison 8. Colloid: different volumes

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Comparison 9. Colloid + crystalloid versus crystalloid

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	2	107	Risk Ratio (M‐H, Random, 95% CI)	0.29 [0.04, 2.14]

2 Women with nausea and/or vomiting Show forest plot	1	40	Risk Ratio (M‐H, Random, 95% CI)	1.0 [0.07, 14.90]

2.1 Nausea	1	40	Risk Ratio (M‐H, Random, 95% CI)	1.0 [0.07, 14.90]
3 Neonates with Apgar score less than 7 at 5 minutes Show forest plot	2	107	Risk Ratio (M‐H, Random, 95% CI)	0.07 [0.00, 1.24]

Comparison 9. Colloid + crystalloid versus crystalloid

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Comparison 10. Colloid + crystalloid versus another colloid + crystalloid

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	1	45	Risk Ratio (M‐H, Random, 95% CI)	0.13 [0.01, 2.30]

1.1 Albumin or dextrose versus dextrose	1	45	Risk Ratio (M‐H, Random, 95% CI)	0.13 [0.01, 2.30]
2 Neonates: Apgar score less than 7 Show forest plot	1	45	Risk Ratio (M‐H, Random, 95% CI)	0.13 [0.01, 2.30]

2.1 Albumin or dextrose versus dextrose	1	45	Risk Ratio (M‐H, Random, 95% CI)	0.13 [0.01, 2.30]

Comparison 10. Colloid + crystalloid versus another colloid + crystalloid

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Comparison 11. Ephedrine versus control

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	7	470	Risk Ratio (M‐H, Random, 95% CI)	0.51 [0.33, 0.78]

2 Women with nausea and/or vomiting Show forest plot	6		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 Nausea and/or vomiting	2	86	Risk Ratio (M‐H, Random, 95% CI)	0.88 [0.47, 1.65]
2.2 Nausea	4	324	Risk Ratio (M‐H, Random, 95% CI)	0.73 [0.46, 1.17]
2.3 Vomiting	3	300	Risk Ratio (M‐H, Random, 95% CI)	0.92 [0.54, 1.56]
4 Women with hypertension requiring intervention Show forest plot	3	300	Risk Ratio (M‐H, Random, 95% CI)	1.49 [0.83, 2.68]

5 Neonates with acidosis (pH less than 7.2) Show forest plot	5	384	Risk Ratio (M‐H, Random, 95% CI)	1.07 [0.47, 2.47]

6 Neonates: Apgar score Show forest plot	4		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

6.1 Less than 8 at 5 minutes	3	300	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
6.2 Less than 7 at 5 minutes	1	66	Risk Ratio (M‐H, Random, 95% CI)	1.34 [0.06, 31.56]

Comparison 11. Ephedrine versus control

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Comparison 12. Ephedrine versus crystalloid

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	4	293	Risk Ratio (M‐H, Random, 95% CI)	0.70 [0.50, 0.96]

2 Women with nausea and/or vomiting Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 Nausea and/or vomiting	1	46	Risk Ratio (M‐H, Random, 95% CI)	1.0 [0.45, 2.21]
2.2 Nausea	1	120	Risk Ratio (M‐H, Random, 95% CI)	0.61 [0.33, 1.10]
2.3 Vomiting	1	120	Risk Ratio (M‐H, Random, 95% CI)	0.67 [0.25, 1.79]
3 Women with impaired consciousness Show forest plot	1	46	Risk Ratio (M‐H, Random, 95% CI)	0.4 [0.09, 1.86]

4 Women with hypertension requiring intervention Show forest plot	1	120	Risk Ratio (M‐H, Random, 95% CI)	1.17 [0.48, 2.81]

5 Neonates with acidosis (pH less than 7.2) Show forest plot	1	118	Risk Ratio (M‐H, Random, 95% CI)	1.41 [0.48, 4.15]

6 Neonatal Apgar score Show forest plot	3		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

6.1 Less than 8 at 5 minutes	2	66	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
6.2 Less than 7 at 5 minutes	1	120	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 12. Ephedrine versus crystalloid

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Comparison 13. Ephedrine versus ephedrine + crystalloid

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	2	181	Risk Ratio (M‐H, Random, 95% CI)	1.21 [0.84, 1.75]

Comparison 13. Ephedrine versus ephedrine + crystalloid

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Comparison 14. Ephedrine + crystalloid versus crystalloid

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	11	651	Risk Ratio (M‐H, Random, 95% CI)	0.71 [0.53, 0.96]

2 Women with nausea and/or vomiting Show forest plot	4		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 Nausea and/or vomiting	1	30	Risk Ratio (M‐H, Random, 95% CI)	0.10 [0.01, 0.69]
2.2 Nausea	3	181	Risk Ratio (M‐H, Random, 95% CI)	0.77 [0.47, 1.25]
2.3 Vomiting	2	101	Risk Ratio (M‐H, Random, 95% CI)	0.56 [0.15, 2.18]
3 Women with hypertension requiring intervention Show forest plot	3	170	Risk Ratio (M‐H, Random, 95% CI)	1.89 [0.82, 4.35]

4 Women with cardiac dysrhythmia Show forest plot	2		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

4.1 Bradycardia	1	54	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.2 Tachycardia	1	40	Risk Ratio (M‐H, Fixed, 95% CI)	1.08 [0.70, 1.66]
5 Neonates with acidosis (pH less than 7.2) Show forest plot	3	142	Risk Ratio (M‐H, Random, 95% CI)	2.28 [0.67, 7.70]

6 Neonatal Apgar score Show forest plot	9		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

6.1 Less than 7 at 5 minutes	2	110	Risk Ratio (M‐H, Random, 95% CI)	0.33 [0.01, 7.58]
6.2 Less than 8 at 5 minutes	7	290	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 14. Ephedrine + crystalloid versus crystalloid

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Comparison 15. Ephedrine + crystalloid versus colloid

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	1	75	Risk Ratio (M‐H, Random, 95% CI)	1.53 [0.89, 2.62]

2 Women with nausea and/or vomiting Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 Nausea	1	75	Risk Ratio (M‐H, Random, 95% CI)	2.36 [1.24, 4.50]
2.2 Vomiting	1	75	Risk Ratio (M‐H, Random, 95% CI)	6.0 [1.30, 27.61]

Comparison 15. Ephedrine + crystalloid versus colloid

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Comparison 16. Ephedrine + colloid versus colloid

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	1	75	Risk Ratio (M‐H, Random, 95% CI)	0.42 [0.22, 0.81]

2 Women with nausea and/or vomiting Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 Nausea	1	75	Risk Ratio (M‐H, Random, 95% CI)	0.23 [0.10, 0.53]
2.2 Vomiting	1	75	Risk Ratio (M‐H, Random, 95% CI)	0.25 [0.07, 0.92]

Comparison 16. Ephedrine + colloid versus colloid

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Comparison 17. Ephedrine + colloid versus crystalloid

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	1	75	Risk Ratio (M‐H, Random, 95% CI)	0.39 [0.21, 0.74]

2 Women with nausea and/or vomiting Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 Nausea	1	75	Risk Ratio (M‐H, Random, 95% CI)	0.27 [0.11, 0.65]
2.2 Vomiting	1	75	Risk Ratio (M‐H, Random, 95% CI)	0.38 [0.09, 1.55]

Comparison 17. Ephedrine + colloid versus crystalloid

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Comparison 18. Ephedrine + colloid versus ephedrine + crystalloid

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	1	100	Risk Ratio (M‐H, Random, 95% CI)	0.65 [0.34, 1.24]

2 Women with nausea and/or vomiting Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 Nausea	1	100	Risk Ratio (M‐H, Random, 95% CI)	0.55 [0.22, 1.36]
2.2 Vomiting	1	100	Risk Ratio (M‐H, Random, 95% CI)	1.0 [0.15, 6.82]

Comparison 18. Ephedrine + colloid versus ephedrine + crystalloid

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Comparison 19. Ephedrine versus phenylephrine

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	3	97	Risk Ratio (M‐H, Random, 95% CI)	0.95 [0.37, 2.44]

4 Neonates with acidosis (pH less than 7.2) Show forest plot	1	17	Risk Ratio (M‐H, Random, 95% CI)	0.89 [0.07, 12.00]

5 Neonates with Apgar score less than 8 at 5 minutes Show forest plot	1	17	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 19. Ephedrine versus phenylephrine

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Comparison 20. Ephedrine + crystalloid versus phenylephrine + crystalloid

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypertension requiring intervention Show forest plot	2	111	Risk Ratio (M‐H, Fixed, 95% CI)	0.84 [0.60, 1.18]

2 Women with nausea and/or vomiting Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

2.1 Nausea	1	30	Risk Ratio (M‐H, Fixed, 95% CI)	0.4 [0.14, 1.17]
2.2 Vomiting	1	30	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Women with cardiac dysrhythmia Show forest plot	2		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

3.1 Bradycardia	2	111	Risk Ratio (M‐H, Fixed, 95% CI)	0.10 [0.01, 2.00]
4 Neonatal Apgar score less than 8 at 5 minutes Show forest plot	2	111	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 20. Ephedrine + crystalloid versus phenylephrine + crystalloid

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Comparison 21. Ephedrine versus ephedrine + phenylephrine

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	1	40	Risk Ratio (M‐H, Random, 95% CI)	1.19 [0.93, 1.51]

2 Women with nausea Show forest plot	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.5 [0.05, 5.08]

3 Neonates with Apgar less than 8 at 5 minutes Show forest plot	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 21. Ephedrine versus ephedrine + phenylephrine

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Comparison 22. Ephedrine versus angiotensin

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	1	20	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

2 Women with nausea and/or vomiting Show forest plot	1	20	Risk Ratio (M‐H, Random, 95% CI)	3.00 [0.14, 65.90]

3 Neonates with acidosis (pH less than 7.2) Show forest plot	1	20	Risk Ratio (M‐H, Random, 95% CI)	9.00 [0.55, 147.95]

Comparison 22. Ephedrine versus angiotensin

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Comparison 23. Ephedrine: different doses

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 5 mg versus 10 mg	1	40	Risk Ratio (M‐H, Random, 95% CI)	1.09 [0.64, 1.86]
1.2 6 mg versus 12 mg	1	46	Risk Ratio (M‐H, Random, 95% CI)	1.83 [0.83, 4.04]
1.3 5 mg versus 15 mg	1	40	Risk Ratio (M‐H, Random, 95% CI)	2.0 [0.94, 4.27]
1.4 10 mg versus 15 mg	1	40	Risk Ratio (M‐H, Random, 95% CI)	1.83 [0.84, 3.99]
2 Women with nausea and/or vomiting Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 6 mg versus 12 mg (nausea and/or vomiting)	1	46	Risk Ratio (M‐H, Random, 95% CI)	0.81 [0.38, 1.74]
2.2 5 mg versus 10 mg (vomiting)	1	40	Risk Ratio (M‐H, Random, 95% CI)	3.00 [0.34, 26.45]
2.3 5 mg versus 15 mg (vomiting)	1	40	Risk Ratio (M‐H, Random, 95% CI)	1.5 [0.28, 8.04]
2.4 10 mg versus 15 mg (vomiting)	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.5 [0.05, 5.08]
2.6 5 mg versus 10 mg (nausea)	1	40	Risk Ratio (M‐H, Random, 95% CI)	2.0 [0.83, 4.81]
2.7 5 mg versus 15 mg (nausea)	1	40	Risk Ratio (M‐H, Random, 95% CI)	2.5 [0.94, 6.66]
2.8 10 mg versus 15 mg (nausea)	1	40	Risk Ratio (M‐H, Random, 95% CI)	1.25 [0.39, 3.99]
3 Women with hypertension requiring intervention Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

3.1 5 mg versus 10 mg	1	40	Risk Ratio (M‐H, Random, 95% CI)	1.2 [0.44, 3.30]
3.2 5 mg versus 15 mg	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.5 [0.23, 1.07]
3.3 10 mg versus 15 mg	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.42 [0.18, 0.96]
4 Neonates with acidosis (pH less than 7.2) Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

4.1 5 mg versus 10 mg	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.2 [0.01, 3.92]
4.2 5 mg versus 15 mg	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.33 [0.01, 7.72]
4.3 6 mg versus 12 mg	1	46	Risk Ratio (M‐H, Random, 95% CI)	0.31 [0.01, 7.16]
4.4 10 mg versus 15 mg	1	40	Risk Ratio (M‐H, Random, 95% CI)	2.0 [0.20, 20.33]
5 Neonatal Apgar score at 5 minutes Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

5.1 Less than 7: 6 mg versus 12 mg	1	46	Risk Ratio (M‐H, Random, 95% CI)	0.31 [0.01, 7.16]
5.2 Less than 8: 5 mg versus 10 mg	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
5.3 Less than 8: 5 mg versus 15 mg	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
5.4 Less than 8: 10 mg versus 15 mg	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 23. Ephedrine: different doses

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Comparison 24. Ephedrine: different rates

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	3		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 Bolus + infusion versus infusion	1	80	Risk Ratio (M‐H, Random, 95% CI)	3.5 [1.26, 9.72]
1.2 0.5 mg/min versus 1 mg/min	1	40	Risk Ratio (M‐H, Random, 95% CI)	1.22 [0.65, 2.29]
1.3 0.5 mg/min versus 2 mg/min	1	40	Risk Ratio (M‐H, Random, 95% CI)	1.57 [0.77, 3.22]
1.4 0.5 mg/min versus 4 mg/min	1	40	Risk Ratio (M‐H, Random, 95% CI)	1.22 [0.65, 2.29]
1.5 1 mg/min versus 2 mg/min	2	88	Risk Ratio (M‐H, Random, 95% CI)	1.09 [0.69, 1.72]
1.6 1 mg/min versus 3 to 4 mg/min	2	99	Risk Ratio (M‐H, Random, 95% CI)	1.29 [0.81, 2.05]
1.7 2 mg/min versus 3 to 4 mg/min	2	239	Risk Ratio (M‐H, Random, 95% CI)	1.21 [0.60, 2.43]
2 Women with nausea and/or vomiting Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 Bolus + infusion versus infusion (nausea)	1	80	Risk Ratio (M‐H, Random, 95% CI)	1.83 [0.75, 4.48]
2.2 0.5 mg/min versus 1 mg/min (nausea)	1	40	Risk Ratio (M‐H, Random, 95% CI)	1.29 [0.60, 2.77]
2.3 0.5 mg/min versus 2 mg/min (nausea)	1	40	Risk Ratio (M‐H, Random, 95% CI)	1.5 [0.66, 3.43]
2.4 0.5 mg/min versus 4 mg/min (nausea)	1	40	Risk Ratio (M‐H, Random, 95% CI)	1.29 [0.60, 2.77]
2.5 1 mg/min versus 2 mg/min (nausea)	1	40	Risk Ratio (M‐H, Random, 95% CI)	1.17 [0.48, 2.86]
2.6 1 mg/min versus 4 mg/min (nausea)	1	40	Risk Ratio (M‐H, Random, 95% CI)	1.0 [0.43, 2.33]
2.7 2 mg/min versus 4 mg/min (nausea)	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.86 [0.35, 2.10]
2.8 Bolus + infusion versus infusion (vomiting)	1	80	Risk Ratio (M‐H, Random, 95% CI)	1.67 [0.43, 6.51]
2.9 0.5 mg/min versus 1 mg/min (vomiting)	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.67 [0.12, 3.57]
2.10 0.5 mg/min versus 2 mg/min (vomiting)	1	40	Risk Ratio (M‐H, Random, 95% CI)	2.0 [0.20, 20.33]
2.11 0.5 mg/min versus 4 mg/min (vomiting)	1	40	Risk Ratio (M‐H, Random, 95% CI)	2.0 [0.20, 20.33]
2.12 1 mg/min versus 2 mg/min (vomiting)	1	40	Risk Ratio (M‐H, Random, 95% CI)	3.00 [0.34, 26.45]
2.13 1 mg/min versus 4 mg/min (vomiting)	1	40	Risk Ratio (M‐H, Random, 95% CI)	3.00 [0.34, 26.45]
2.14 2 mg/min versus 4 mg/min (vomiting)	1	40	Risk Ratio (M‐H, Random, 95% CI)	1.0 [0.07, 14.90]
3 Women with hypertension requiring intervention Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

3.1 Bolus + infusion versus infusion	1	80	Risk Ratio (M‐H, Random, 95% CI)	1.0 [0.39, 2.59]
3.2 0.5 mg/min versus 1 mg/min	1	40	Risk Ratio (M‐H, Random, 95% CI)	5.0 [0.26, 98.00]
3.3 0.5 mg/min versus 2 mg/min	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.67 [0.12, 3.57]
3.4 0.5 mg/min versus 4 mg/min	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.2 [0.05, 0.80]
3.5 1 mg/min versus 2 mg/min	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.14 [0.01, 2.60]
3.6 1 mg/min versus 4 mg/min	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.05 [0.00, 0.76]
3.7 2 mg/min versus 4 mg/min	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.30 [0.10, 0.93]
4 Neonates with acidosis (pH less than 7.2) Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

4.1 Bolus + infusion versus infusion	1	78	Risk Ratio (M‐H, Random, 95% CI)	1.66 [0.53, 5.23]
4.2 0.5 mg/min versus 1 mg/min	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.33 [0.04, 2.94]
4.3 0.5 mg/min versus 2 mg/min	1	40	Risk Ratio (M‐H, Random, 95% CI)	3.00 [0.13, 69.52]
4.4 0.5 mg/min versus 4 mg/min	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.25 [0.03, 2.05]
4.5 1 mg/min versus 2 mg/min	1	40	Risk Ratio (M‐H, Random, 95% CI)	7.0 [0.38, 127.32]
4.6 1 mg/min versus 4 mg/min	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.75 [0.19, 2.93]
4.7 2 mg/min versus 4 mg/min	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.11 [0.01, 1.94]
5 Neonatal Apgar score at 5 min Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

5.1 Bolus + infusion versus infusion (less than 7)	1	80	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
5.2 0.5 mg/min versus 1 mg/min (less than 8)	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
5.3 0.5 mg/min versus 2 mg/min (less than 8)	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
5.4 0.5 mg/min versus 4 mg/min (less than 8)	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
5.5 1 mg/min versus 2 mg/min (less than 8)	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
5.6 1 mg/min versus 4 mg/min (less than 8)	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
5.7 2 mg/min versus 4 mg/min (less than 8)	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 24. Ephedrine: different rates

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Comparison 25. Ephedrine + crystalloid: different doses or rates

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	6		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 5 mg versus 10 mg	1	60	Risk Ratio (M‐H, Random, 95% CI)	0.88 [0.29, 2.64]
1.2 10 mg versus 20 mg	2	60	Risk Ratio (M‐H, Random, 95% CI)	1.06 [0.80, 1.39]
1.3 10 mg versus 30 mg	1	40	Risk Ratio (M‐H, Random, 95% CI)	2.43 [1.30, 4.54]
1.4 15 mg versus 30 mg ephedrine	1	50	Risk Ratio (M‐H, Random, 95% CI)	2.4 [0.99, 5.81]
1.5 20 mg versus 30 mg	1	40	Risk Ratio (M‐H, Random, 95% CI)	2.29 [1.21, 4.32]
1.6 1 mg/min versus 2 mg/min	2	70	Risk Ratio (M‐H, Random, 95% CI)	1.36 [0.69, 2.68]
1.7 1 mg/min versus 3 to 4 mg/min	1	53	Risk Ratio (M‐H, Random, 95% CI)	1.87 [0.79, 4.40]
1.8 2 mg/min versus 3 to 4 mg/min	1	53	Risk Ratio (M‐H, Random, 95% CI)	1.87 [0.79, 4.40]
2 Women with nausea and/or vomiting Show forest plot	3		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 Nausea: 10 mg versus 20 mg ephedrine	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.69 [0.39, 1.24]
2.2 Nausea: 10 mg versus 30 mg ephedrine	1	40	Risk Ratio (M‐H, Random, 95% CI)	1.8 [0.73, 4.43]
2.3 Nausea: 15 mg versus 30 mg ephedrine	1	50	Risk Ratio (M‐H, Random, 95% CI)	1.75 [0.58, 5.24]
2.4 Nausea: 20 mg versus 30 mg ephedrine	1	40	Risk Ratio (M‐H, Random, 95% CI)	2.60 [1.14, 5.93]
2.5 Nausea: 1 mg/min versus 2 mg/min	1	20	Risk Ratio (M‐H, Random, 95% CI)	9.00 [0.55, 147.95]
2.6 Vomiting: 15 mg versus 30 mg ephedrine	1	50	Risk Ratio (M‐H, Random, 95% CI)	1.0 [0.07, 15.12]
3 Women with hypertension requiring intervention Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

3.1 10 mg versus 20 mg	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.2 [0.03, 1.56]
3.2 10 mg versus 30 mg	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.11 [0.02, 0.80]
3.3 20 mg versus 30 mg	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.56 [0.23, 1.37]
4 Women with cardiac dysrhythmia Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

4.1 1 mg/min versus 2 mg/min	1	20	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
5 Neonates with acidosis (pH less than 7.2) Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

5.1 10 mg versus 20 mg	1	39	Risk Ratio (M‐H, Random, 95% CI)	0.59 [0.24, 1.50]
5.2 10 mg versus 30 mg	1	38	Risk Ratio (M‐H, Random, 95% CI)	1.13 [0.36, 3.55]
5.3 20 mg versus 30 mg	1	37	Risk Ratio (M‐H, Random, 95% CI)	1.89 [0.69, 5.21]
6 Neonatal Apgar score at 5 minutes Show forest plot	3		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

6.1 10 mg versus 20 mg: less than 7	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
6.2 10 mg versus 30 mg: less than 7	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
6.3 20 mg versus 30 mg: less than 7	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
6.4 10 mg versus 20 mg: less than 8	1	20	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
6.5 1 mg/min versus 2 mg/min: less than 8	1	20	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 25. Ephedrine + crystalloid: different doses or rates

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Comparison 26. Ephedrine + colloid: different doses

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 15 mg versus 30 mg	1	50	Risk Ratio (M‐H, Random, 95% CI)	1.75 [0.58, 5.24]
2 Women with nausea and/or vomiting Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 Nausea: 15 mg versus 30 mg ephedrine	1	50	Risk Ratio (M‐H, Random, 95% CI)	1.0 [0.22, 4.49]
2.2 Vomiting: 15 mg versus 30 mg ephedrine	1	50	Risk Ratio (M‐H, Random, 95% CI)	0.5 [0.05, 5.17]

Comparison 26. Ephedrine + colloid: different doses

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Comparison 27. Ephedrine + colloid + crystalloid versus colloid + crystalloid

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 Any hypotension	2	135	Risk Ratio (M‐H, Random, 95% CI)	0.42 [0.20, 0.87]
1.2 Less than 90 mmHg	1	48	Risk Ratio (M‐H, Random, 95% CI)	0.2 [0.05, 0.82]
2 Nausea and vomiting Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 Nausea	1	48	Risk Ratio (M‐H, Random, 95% CI)	0.56 [0.31, 1.01]
2.2 Vomiting	1	48	Risk Ratio (M‐H, Random, 95% CI)	1.0 [0.07, 15.08]
3 Neonates with acidosis (pH less than 7.2) Show forest plot	1	48	Risk Ratio (M‐H, Random, 95% CI)	0.5 [0.05, 5.15]

4 Neonatal Apgar score Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

4.1 Less than 7 at 5 minutes	1	87	Risk Ratio (M‐H, Random, 95% CI)	1.43 [0.34, 6.01]
4.2 Less than 8 at 5 minutes	1	48	Risk Ratio (M‐H, Random, 95% CI)	1.0 [0.07, 15.08]

Comparison 27. Ephedrine + colloid + crystalloid versus colloid + crystalloid

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Comparison 28. Phenylephrine versus control

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	2	110	Risk Ratio (M‐H, Random, 95% CI)	0.27 [0.16, 0.45]

2 Women with nausea and/or vomiting Show forest plot	1	50	Risk Ratio (M‐H, Random, 95% CI)	0.18 [0.02, 1.47]

3 Women with cardiac dysrhythmia Show forest plot	1	50	Risk Ratio (M‐H, Random, 95% CI)	4.63 [0.23, 91.81]

4 Neonates with acidosis (pH less than 7.2) Show forest plot	1	49	Risk Ratio (M‐H, Random, 95% CI)	0.96 [0.06, 14.50]

5 Neonates with Apgar less than 7 at 5 minutes Show forest plot	1	50	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 28. Phenylephrine versus control

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Comparison 29. Phenylephrine + crystalloid versus crystalloid

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	1	81	Risk Ratio (M‐H, Random, 95% CI)	0.75 [0.51, 1.09]

2 Women with cardiac dysrhythmia Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 Bradycardia	1	81	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
3 Neonates with Apgar less than 8 at 5 minutes Show forest plot	1	81	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 29. Phenylephrine + crystalloid versus crystalloid

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Comparison 30. Phenylephrine + crystalloid: different doses

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 2 mg versus 4 mg	1	54	Risk Ratio (M‐H, Random, 95% CI)	2.0 [1.10, 3.63]
2 Women with cardiac dysrhythmia Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 Bradycardia: 2 mg versus 4 mg	1	54	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
3 Neonatal Apgar score less than 8 at 5 minutes Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

3.1 2 mg versus 4 mg	1	54	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 30. Phenylephrine + crystalloid: different doses

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Comparison 31. Angiotensin versus control

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	1	20	Risk Ratio (M‐H, Random, 95% CI)	0.09 [0.01, 1.45]

2 Women with nausea and/or vomiting Show forest plot	1	20	Risk Ratio (M‐H, Random, 95% CI)	0.2 [0.01, 3.70]

3 Neonates with acidosis (pH less than 7.2) Show forest plot	1	20	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 31. Angiotensin versus control

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Comparison 32. Dopamine + crystalloid versus crystalloid

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypertension requiring intervention Show forest plot	1	30	Risk Ratio (M‐H, Random, 95% CI)	0.05 [0.00, 0.75]

2 Neonatal Apgar score less than 8 at 5 minutes Show forest plot	1	30	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 32. Dopamine + crystalloid versus crystalloid

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Comparison 33. Glycopyrrolate + crystalloid versus crystalloid

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	2	89	Risk Ratio (M‐H, Random, 95% CI)	0.84 [0.63, 1.13]

2 Women with nausea and/or vomiting Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 Nausea and vomiting	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.6 [0.27, 1.34]
2.2 Nausea	1	49	Risk Ratio (M‐H, Random, 95% CI)	0.61 [0.36, 1.06]
2.3 Vomiting	1	49	Risk Ratio (M‐H, Random, 95% CI)	0.52 [0.10, 2.59]
3 Women with cardiac dysrhythmia requiring intervention Show forest plot	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

4 Neonates with Apgar score less than 8 at 5 minutes Show forest plot	1	49	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

5 Neonates admitted to neonatal intensive care unit Show forest plot	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 33. Glycopyrrolate + crystalloid versus crystalloid

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Comparison 34. Glycopyrrolate versus ephedrine

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	1	18	Risk Ratio (M‐H, Random, 95% CI)	1.33 [0.80, 2.23]

2 Women with nausea and/or vomiting Show forest plot	1	18	Risk Ratio (M‐H, Random, 95% CI)	1.0 [0.44, 2.29]

3 Women with cardiac dysrhythmia requiring intervention Show forest plot	1	18	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

4 Neonates admitted to neonatal intensive care unit Show forest plot	1	18	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 34. Glycopyrrolate versus ephedrine

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Comparison 35. Lower limb compression versus control

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	7	399	Risk Ratio (M‐H, Random, 95% CI)	0.69 [0.53, 0.90]

2 Women with nausea and/or vomiting Show forest plot	1	30	Risk Ratio (M‐H, Random, 95% CI)	0.09 [0.01, 1.51]

3 Neonates with Apgar score less than 8 at 5 minutes Show forest plot	3	130	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 35. Lower limb compression versus control

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Comparison 36. Hip flexion versus legs straight

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Neonatal Apgar score less than 7 at 5 minutes Show forest plot	1	68	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 36. Hip flexion versus legs straight

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Comparison 37. Leg elevation versus control

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	1	63	Risk Ratio (M‐H, Random, 95% CI)	0.73 [0.42, 1.26]

Comparison 37. Leg elevation versus control

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Comparison 38. Lateral versus supine wedged position

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.89 [0.73, 1.10]

2 Women with cardiac dysrhythmia requiring intervention Show forest plot	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.5 [0.05, 5.08]

3 Neonates admitted to neonatal intensive care unit Show forest plot	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 38. Lateral versus supine wedged position

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Comparison 39. Lateral recumbent versus sitting

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	2	82	Risk Ratio (M‐H, Random, 95% CI)	1.10 [0.73, 1.65]

2 Women with nausea and/or vomiting Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 Nausea and/or vomiting	1	22	Risk Ratio (M‐H, Random, 95% CI)	1.0 [0.43, 2.31]
2.2 Nausea	1	60	Risk Ratio (M‐H, Random, 95% CI)	2.0 [0.19, 20.90]
2.3 Vomiting	2	82	Risk Ratio (M‐H, Random, 95% CI)	0.9 [0.26, 3.11]

Comparison 39. Lateral recumbent versus sitting

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Comparison 40. Left lateral versus right lateral

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Nausea and vomiting Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 Nausea	1	60	Risk Ratio (M‐H, Random, 95% CI)	0.78 [0.48, 1.26]
1.2 Vomiting	1	60	Risk Ratio (M‐H, Random, 95% CI)	0.17 [0.02, 1.30]
1.3 Requiring antiemetics	1	60	Risk Ratio (M‐H, Random, 95% CI)	0.73 [0.34, 1.55]

Comparison 40. Left lateral versus right lateral

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Comparison 41. Left lateral versus left lateral tilt

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	2	145	Risk Ratio (M‐H, Random, 95% CI)	0.98 [0.72, 1.34]

1.1 15 degree tilt	1	58	Risk Ratio (M‐H, Random, 95% CI)	1.20 [0.80, 1.79]
1.3 12 (20) degree tilt: any hypotension	1	87	Risk Ratio (M‐H, Random, 95% CI)	0.88 [0.74, 1.05]
2 Women with nausea and/or vomiting Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 Nausea: 15 degree tilt	1	58	Risk Ratio (M‐H, Random, 95% CI)	0.45 [0.18, 1.11]
2.2 Vomiting: 15 degree tilt	1	58	Risk Ratio (M‐H, Random, 95% CI)	0.15 [0.01, 2.83]
3 Women with cardiac dysrhythmia requiring intervention Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

3.1 Bradycardia	1	58	Risk Ratio (M‐H, Fixed, 95% CI)	0.10 [0.01, 1.68]

Comparison 41. Left lateral versus left lateral tilt

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Comparison 42. Crawford's wedge versus manual uterine displacement

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.92 [0.57, 1.49]

2 Neonates with Apgar score less than 8 at 5 minutes Show forest plot	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 42. Crawford's wedge versus manual uterine displacement

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Comparison 43. Oxford position versus right lateral

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	1	60	Risk Ratio (M‐H, Random, 95% CI)	0.96 [0.83, 1.12]

2 Women with nausea and/or vomiting Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 Nausea	1	60	Risk Ratio (M‐H, Random, 95% CI)	1.5 [0.27, 8.34]
2.2 Vomiting	1	60	Risk Ratio (M‐H, Random, 95% CI)	3.00 [0.13, 70.83]

Comparison 43. Oxford position versus right lateral

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Comparison 44. Oxford position versus sitting

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring treatment Show forest plot	1	60	Risk Ratio (M‐H, Random, 95% CI)	1.29 [0.99, 1.67]

2 Women with nausea and/or vomiting Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 Nausea	1	60	Risk Ratio (M‐H, Random, 95% CI)	3.00 [0.33, 27.23]
2.2 Vomiting	1	60	Risk Ratio (M‐H, Random, 95% CI)	3.00 [0.13, 70.83]

Comparison 44. Oxford position versus sitting

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Comparison 45. Supine versus sitting

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	1	98	Risk Ratio (M‐H, Random, 95% CI)	0.81 [0.58, 1.12]

2 Women with nausea and/or vomiting Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 Nausea	1	98	Risk Ratio (M‐H, Random, 95% CI)	0.65 [0.40, 1.07]
2.2 Vomiting	1	98	Risk Ratio (M‐H, Random, 95% CI)	0.38 [0.02, 9.01]
3 Neonates with acidosis (pH less than 7.2) Show forest plot	1	98	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

4 Neonates with Apgar less than 7 at 5 minutes Show forest plot	1	98	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 45. Supine versus sitting

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Comparison 46. Delayed versus immediate recumbence

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with nausea and/or vomiting Show forest plot	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.4 [0.15, 1.07]

Comparison 46. Delayed versus immediate recumbence

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Comparison 47. Head‐up tilt versus control

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	2	74	Risk Ratio (M‐H, Random, 95% CI)	0.84 [0.63, 1.11]

1.1 Head‐up tilt (10 degrees) versus horizontal	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.71 [0.47, 1.06]
1.2 Horizontal versus head‐down tilt (10 degrees)	1	34	Risk Ratio (M‐H, Random, 95% CI)	0.93 [0.71, 1.24]
2 Neonates with Apgar score less than 8 at 5 minutes Show forest plot	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 47. Head‐up tilt versus control

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Comparison 48. Acupressure versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	1	50	Risk Ratio (M‐H, Random, 95% CI)	0.84 [0.58, 1.22]

2 Women with nausea and/or vomiting Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 Nausea and/or vomiting	0	0	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
2.2 Nausea	1	50	Risk Ratio (M‐H, Random, 95% CI)	0.32 [0.15, 0.66]
2.3 Vomiting	1	50	Risk Ratio (M‐H, Random, 95% CI)	0.5 [0.14, 1.78]
3 Neonates with Apgar less than 7 at 5 minutes Show forest plot	1	50	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 48. Acupressure versus placebo

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Comparison 49. Acupressure versus metoclopramide

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Women with hypotension requiring intervention Show forest plot	1	50	Risk Ratio (M‐H, Random, 95% CI)	0.94 [0.63, 1.40]

2 Women with nausea and/or vomiting Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 Nausea and/or vomiting	0	0	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
2.2 Nausea	1	50	Risk Ratio (M‐H, Random, 95% CI)	1.5 [0.48, 4.68]
2.3 Vomiting	1	50	Risk Ratio (M‐H, Random, 95% CI)	3.00 [0.33, 26.92]
3 Neonates with Apgar less than 7 at 5 minutes Show forest plot	1	50	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 49. Acupressure versus metoclopramide

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