Analgesia for forceps delivery

Payam Nikpoor; Emily Bain

doi:10.1002/14651858.CD008878.pub2

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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 Diazepam versus ketamine, Outcome 1 Pain relief (judged as effective by the mother).

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Analysis 1.2

Comparison 1 Diazepam versus ketamine, Outcome 2 Maternal apnoea requiring oxygen ventilation.

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Analysis 1.3

Comparison 1 Diazepam versus ketamine, Outcome 3 Apgar score of less than seven at five minutes.

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Analysis 1.4

Comparison 1 Diazepam versus ketamine, Outcome 4 Acidosis as defined by cord blood arterial pH less than 7.2.

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Analysis 1.5

Comparison 1 Diazepam versus ketamine, Outcome 5 Good anaesthesia (judged by the obstetrician).

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Analysis 1.6

Comparison 1 Diazepam versus ketamine, Outcome 6 Pleasant recovery (judged by the mother).

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Analysis 1.7

Comparison 1 Diazepam versus ketamine, Outcome 7 Awareness (mother sensed the operation).

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Analysis 2.1

Comparison 2 Diazepam versus vinydan‐ether, Outcome 1 Pain relief (judged as effective by the mother).

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Analysis 2.2

Comparison 2 Diazepam versus vinydan‐ether, Outcome 2 Vomiting.

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Analysis 2.3

Comparison 2 Diazepam versus vinydan‐ether, Outcome 3 Apgar score of less than seven at five minutes.

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Analysis 2.4

Comparison 2 Diazepam versus vinydan‐ether, Outcome 4 Good anaesthesia (judged by the obstetrician).

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Analysis 2.5

Comparison 2 Diazepam versus vinydan‐ether, Outcome 5 Comfortable induction and recovery (judged by the mother).

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Analysis 3.1

Comparison 3 Diazepam versus other (general, local, other anaesthetic), Outcome 1 Apgar score of less than eight at two minutes.

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Analysis 4.1

Comparison 4 Spinal analgesia versus pudendal block anaesthesia, Outcome 1 Pain relief (analgesia achieved).

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Analysis 4.2

Comparison 4 Spinal analgesia versus pudendal block anaesthesia, Outcome 2 Severe pain during delivery.

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Analysis 4.3

Comparison 4 Spinal analgesia versus pudendal block anaesthesia, Outcome 3 Serious maternal complications.

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Analysis 4.4

Comparison 4 Spinal analgesia versus pudendal block anaesthesia, Outcome 4 Request for additional anaesthesia.

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Analysis 4.5

Comparison 4 Spinal analgesia versus pudendal block anaesthesia, Outcome 5 Maternal hypotension (defined as a decrease in diastolic or systolic blood pressure of more than 10 mmHg).

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Analysis 4.6

Comparison 4 Spinal analgesia versus pudendal block anaesthesia, Outcome 6 Headache (mild or moderate).

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Comparison 1. Diazepam versus ketamine

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Pain relief (judged as effective by the mother) Show forest plot	1	26	Risk Ratio (M‐H, Fixed, 95% CI)	1.42 [0.98, 2.07]

2 Maternal apnoea requiring oxygen ventilation Show forest plot	1	26	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.07, 14.34]

3 Apgar score of less than seven at five minutes Show forest plot	1	26	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

4 Acidosis as defined by cord blood arterial pH less than 7.2 Show forest plot	1	21	Risk Ratio (M‐H, Fixed, 95% CI)	1.1 [0.08, 15.36]

5 Good anaesthesia (judged by the obstetrician) Show forest plot	1	26	Risk Ratio (M‐H, Fixed, 95% CI)	0.63 [0.41, 0.97]

6 Pleasant recovery (judged by the mother) Show forest plot	1	26	Risk Ratio (M‐H, Fixed, 95% CI)	2.08 [1.17, 3.68]

7 Awareness (mother sensed the operation) Show forest plot	1	26	Risk Ratio (M‐H, Fixed, 95% CI)	0.11 [0.01, 1.88]

Comparison 1. Diazepam versus ketamine

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Comparison 2. Diazepam versus vinydan‐ether

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Pain relief (judged as effective by the mother) Show forest plot	1	101	Risk Ratio (M‐H, Fixed, 95% CI)	1.13 [1.02, 1.25]

2 Vomiting Show forest plot	1	101	Risk Ratio (M‐H, Fixed, 95% CI)	0.04 [0.00, 0.62]

3 Apgar score of less than seven at five minutes Show forest plot	1	104	Risk Ratio (M‐H, Fixed, 95% CI)	1.26 [0.45, 3.50]

4 Good anaesthesia (judged by the obstetrician) Show forest plot	1	101	Risk Ratio (M‐H, Fixed, 95% CI)	1.56 [1.11, 2.21]

5 Comfortable induction and recovery (judged by the mother) Show forest plot	1	101	Risk Ratio (M‐H, Fixed, 95% CI)	3.45 [2.26, 5.26]

Comparison 2. Diazepam versus vinydan‐ether

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Comparison 3. Diazepam versus other (general, local, other anaesthetic)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Apgar score of less than eight at two minutes Show forest plot	1	78	Risk Ratio (M‐H, Fixed, 95% CI)	1.1 [0.51, 2.38]

Comparison 3. Diazepam versus other (general, local, other anaesthetic)

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Comparison 4. Spinal analgesia versus pudendal block anaesthesia

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Pain relief (analgesia achieved) Show forest plot	1	183	Risk Ratio (M‐H, Fixed, 95% CI)	3.36 [2.46, 4.60]

2 Severe pain during delivery Show forest plot	1	183	Risk Ratio (M‐H, Fixed, 95% CI)	0.02 [0.00, 0.27]

3 Serious maternal complications Show forest plot	1	183	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

4 Request for additional anaesthesia Show forest plot	1	183	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

5 Maternal hypotension (defined as a decrease in diastolic or systolic blood pressure of more than 10 mmHg) Show forest plot	1	183	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

6 Headache (mild or moderate) Show forest plot	1	183	Risk Ratio (M‐H, Fixed, 95% CI)	0.91 [0.53, 1.58]

Comparison 4. Spinal analgesia versus pudendal block anaesthesia

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