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Study flow diagram

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Figure 1

Study flow diagram

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

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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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Comparison 1: Paracervical block versus intravenous analgesia, Outcome 1: Postpartum haemorrhage (blood loss ≥ 500 mL)

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Analysis 1.1

Comparison 1: Paracervical block versus intravenous analgesia, Outcome 1: Postpartum haemorrhage (blood loss ≥ 500 mL)

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Comparison 1: Paracervical block versus intravenous analgesia, Outcome 2: Provider's satisfaction with the procedure

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Analysis 1.2

Comparison 1: Paracervical block versus intravenous analgesia, Outcome 2: Provider's satisfaction with the procedure

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Comparison 1: Paracervical block versus intravenous analgesia, Outcome 3: Woman's satisfaction with the procedure

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Analysis 1.3

Comparison 1: Paracervical block versus intravenous analgesia, Outcome 3: Woman's satisfaction with the procedure

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Summary of findings 1. Paracervical block compared to intravenous diazepam/pethidine analgesia for manual removal of retained placenta

Paracervical block compared to intravenous diazepam and pethidine analgesia during manual removal of retained placenta

Patient or population: women with persistent or prolonged retention of placenta
Setting: general hospital, Papua New Guinea
Intervention: paracervical block
Comparison: intravenous pethidine and diazepam analgesia

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with intravenous pethidine and diazepam

Risk with paracervical block

Pain intensity

study did not measure this outcome

Adverse events

study did not measure this outcome

Postpartum haemorrhage (blood loss ≥ 500 mL)

Study population

not estimable

30
(1 RCT)

⊕⊝⊝⊝
Very lowa,b

None of the women lost ≥ 500 mL blood

0 per 1000

0 per 1000
(0 to 0)

Requirement of additional analgesia or general anaesthesia

study did not measure this outcome

Serious maternal morbidity

study did not measure this outcome

Providers' satisfaction with the procedure

Study population

RR 1.50
(0.71 to 3.16)

30
(1 RCT)

⊕⊝⊝⊝
Very lowa,c

400 per 1000

600 per 1000
(284 to 1000)

Women's satisfaction with the procedure

Study population

RR 0.82
(0.49 to 1.37)

30
(1 RCT)

⊕⊝⊝⊝
Very lowa,c

733 per 1000

601 per 1000
(359 to 1000)

*The risk in the intervention group (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 certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect

aDowngraded ‐2 for very serious limitations in study design (risk of bias) – high risk of bias for performance and detection bias; and unclear risk of selection bias and reporting bias.
bDowngraded ‐2 for very serious imprecision – results based on one small study involving 30 women and zero events. cDowngraded ‐2 for very serious imprecision – results based on one small study involving 30 women, wide confidence interval crossing the line of no effect.

Figuras y tablas -
Summary of findings 1. Paracervical block compared to intravenous diazepam/pethidine analgesia for manual removal of retained placenta
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Comparison 1. Paracervical block versus intravenous analgesia

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1.1 Postpartum haemorrhage (blood loss ≥ 500 mL) Show forest plot

1

30

Risk Ratio (IV, Fixed, 95% CI)

Not estimable

1.2 Provider's satisfaction with the procedure Show forest plot

1

30

Risk Ratio (IV, Fixed, 95% CI)

1.50 [0.71, 3.16]

1.3 Woman's satisfaction with the procedure Show forest plot

1

30

Risk Ratio (IV, Fixed, 95% CI)

0.82 [0.49, 1.37]
Figuras y tablas -
Comparison 1. Paracervical block versus intravenous analgesia
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