Techniques for assisting difficult delivery at caesarean section

Heather Waterfall; Rosalie M Grivell; Jodie M Dodd

doi:10.1002/14651858.CD004944.pub3

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Figure 1

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Figure 2

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

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Analysis 1.1

Comparison 1 Tocolysis versus placebo, Outcome 1 Maternal side‐effects (not prespecified).

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Analysis 2.1

Comparison 2 Reverse breech versus head push, Outcome 1 Infant birth trauma.

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Analysis 2.2

Comparison 2 Reverse breech versus head push, Outcome 2 Extension of uterine incision.

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Analysis 2.3

Comparison 2 Reverse breech versus head push, Outcome 3 Blood loss > 500 mL.

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Analysis 2.4

Comparison 2 Reverse breech versus head push, Outcome 4 Mean blood loss.

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Analysis 2.5

Comparison 2 Reverse breech versus head push, Outcome 5 Blood transfusion.

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Analysis 2.6

Comparison 2 Reverse breech versus head push, Outcome 6 Endometritis.

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Analysis 2.7

Comparison 2 Reverse breech versus head push, Outcome 7 Wound infection.

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Analysis 2.8

Comparison 2 Reverse breech versus head push, Outcome 8 Admission to neonatal special care or intensive care unit.

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Analysis 2.9

Comparison 2 Reverse breech versus head push, Outcome 9 Early neonatal death rate.

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Analysis 2.10

Comparison 2 Reverse breech versus head push, Outcome 10 Mean fall in Hb (not prespecified).

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Analysis 2.11

Comparison 2 Reverse breech versus head push, Outcome 11 Operative time (min).

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Analysis 2.12

Comparison 2 Reverse breech versus head push, Outcome 12 Mean hospital stay (not prespecified).

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Analysis 2.13

Comparison 2 Reverse breech versus head push, Outcome 13 Average Apgar at 5 minutes (not prespecified).

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Analysis 3.1

Comparison 3 Elective instrument versus fundal pressure, Outcome 1 Infant birth trauma.

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Analysis 3.2

Comparison 3 Elective instrument versus fundal pressure, Outcome 2 Extension of uterine incision.

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Analysis 3.3

Comparison 3 Elective instrument versus fundal pressure, Outcome 3 Mean fall in Hb.

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Comparison 1. Tocolysis versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Maternal side‐effects (not prespecified) Show forest plot	1	97	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 1. Tocolysis versus placebo

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Comparison 2. Reverse breech versus head push

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Infant birth trauma Show forest plot	3	239	Risk Ratio (M‐H, Fixed, 95% CI)	1.55 [0.42, 5.73]

2 Extension of uterine incision Show forest plot	4	357	Risk Ratio (M‐H, Random, 95% CI)	0.23 [0.13, 0.40]

3 Blood loss > 500 mL Show forest plot	1	118	Risk Ratio (M‐H, Random, 95% CI)	0.5 [0.18, 1.37]

4 Mean blood loss Show forest plot	3	298	Mean Difference (IV, Random, 95% CI)	‐294.92 [‐493.25, ‐96.59]

5 Blood transfusion Show forest plot	2	177	Risk Ratio (M‐H, Random, 95% CI)	0.57 [0.20, 1.66]

6 Endometritis Show forest plot	3	285	Risk Ratio (M‐H, Random, 95% CI)	0.52 [0.26, 1.05]

7 Wound infection Show forest plot	4	357	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.58, 1.59]

8 Admission to neonatal special care or intensive care unit Show forest plot	2	226	Risk Ratio (M‐H, Random, 95% CI)	0.53 [0.23, 1.22]

9 Early neonatal death rate Show forest plot	1	108	Risk Ratio (M‐H, Random, 95% CI)	0.54 [0.23, 1.24]

10 Mean fall in Hb (not prespecified) Show forest plot	1	118	Mean Difference (IV, Random, 95% CI)	‐0.44 [‐0.72, ‐0.16]

11 Operative time (min) Show forest plot	4	357	Mean Difference (IV, Random, 95% CI)	‐14.99 [‐27.67, ‐2.30]

12 Mean hospital stay (not prespecified) Show forest plot	3	285	Mean Difference (IV, Random, 95% CI)	‐1.13 [‐2.75, 0.48]

13 Average Apgar at 5 minutes (not prespecified) Show forest plot	3	239	Mean Difference (IV, Random, 95% CI)	0.36 [‐0.64, 1.36]

Comparison 2. Reverse breech versus head push

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Comparison 3. Elective instrument versus fundal pressure

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Infant birth trauma Show forest plot	1	44	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

2 Extension of uterine incision Show forest plot	1	44	Risk Ratio (M‐H, Fixed, 95% CI)	0.7 [0.13, 3.73]

3 Mean fall in Hb Show forest plot	1	44	Mean Difference (IV, Fixed, 95% CI)	0.03 [‐0.53, 0.59]

Comparison 3. Elective instrument versus fundal pressure

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