Background
Methods
Search strategy
Eligibility criteria
Data collection and assessment
Data analysis/synthesis
Author, year | Study design | Total study population | N | Enrolment period | Location | Type of obstetric procedure | Available outcomes |
---|---|---|---|---|---|---|---|
(treatment, control) | |||||||
Katsulov 1983 [21] | Retrospective cohort study | 100 | 30/70 | 1976–1977 | Bulgaria | Women who underwent manual placenta removal | Endometritis |
Von Rechlin et al. 1988 [22] | Retrospective cohort study | 302 | 65/237 | An undefined period of 6 years | Germany | Women undergoing manual placental removal | Endometritis, fever greater than 37.5 °C |
Tandberg et al. 1999 [23] | Retrospective cohort study | 24,750 births | 61/104 | 1990–1994 | Norway | Women who underwent a manual placenta removal | Endometritis |
Results
Effects of antibiotic prophylaxis on infectious maternal morbidities in vaginal deliveries involving manual placenta removal
NOS (Newcastle-Ottawa Scale) risk of bias assessment for included studies | |||
---|---|---|---|
Study ID | Von Rechlin et al. 1988 [22] | Tandberg et al. 1999 [23] | Katsulov 1983 [21] |
Representativeness of exposed cohort - Truly representative of the average woman (*) - Somewhat representative of the average woman (*) - Selected group of users -No description of the derivation of the cohort | |||
Selection of non-exposed cohort - Drawn from the same community as the exposed cohort (*) - Drawn from a different source - No description of the derivation of the non-exposed cohort | |||
Ascertainment of exposure - Secure records (e.g., surgical records) (*) - Structured interview (*) - Written self-report - No description | |||
Demonstration that outcome of interest was not present at the start of the study - Yes (*) - No | * | ||
Comparability of cohorts on the basis of the design or analysis - Study controls for gestational age and/or birth weight (*) - Study controls for any additional factor (*) | * | ||
Assessment of outcome -Independent blind assessment (*) - Record linkage (*) -Self-report -No description | * | * | |
Follow-up long enough for outcomes to occur - Yes (*) - No | * | * | * |
Adequacy of follow-up of cohorts - Complete follow-up – all subjects accounted for (*) - Subjects lost to follow-up unlikely to introduce bias, or description provided of those lost (*) - No statement | * | * | * |
Total number of stars | 2 | 5 | 3 |
Quality assessment | No of patients | Effect | Quality | Importance | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
No. of studies | Design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | Ab prophylaxis versus none | Control | Relative (95 % CI) | Absolute | ||
Puerperal fever | ||||||||||||
1 | observational studies | very seriousa
| no serious inconsistency | no serious indirectness | seriousb
| none | 58/65 (89.2 %) | 213/237 (89.9 %) | OR 0.93 (0.38 to 2.27) | 7 fewer per 1000 (from 127 fewer to 54 more) | ⊕ΟΟΟ VERY LOW | CRITICAL |
89.9 % | 7 fewer per 1000 (from 127 fewer to 54 more) | |||||||||||
Endometritis | ||||||||||||
3 | observational studies | very seriousa
| no serious inconsistency | no serious indirectness | seriousb
| none | 8/156 (5.1 %) | 31/411 (7.5 %) | OR 0.84 (0.38 to 1.85) | 11 fewer per 1000 (from 45 fewer to 56 more) | ⊕ΟΟΟ VERY LOW | CRITICAL |
7.1 % | 11 fewer per 1000 (from 43 fewer to 53 more) |