Intervention Review

You have free access to this content

Prophylactic interventions after delivery of placenta for reducing bleeding during the postnatal period

  1. Yukari Yaju1,
  2. Yaeko Kataoka2,
  3. Hiromi Eto3,
  4. Shigeko Horiuchi2,
  5. Rintaro Mori4,*

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 26 NOV 2013

Assessed as up-to-date: 9 MAY 2013

DOI: 10.1002/14651858.CD009328.pub2


How to Cite

Yaju Y, Kataoka Y, Eto H, Horiuchi S, Mori R. Prophylactic interventions after delivery of placenta for reducing bleeding during the postnatal period. Cochrane Database of Systematic Reviews 2013, Issue 11. Art. No.: CD009328. DOI: 10.1002/14651858.CD009328.pub2.

Author Information

  1. 1

    St. Luke's College of Nursing, Research Center for Development of Nursing Practice, Tsukiji, Chuo-ku, Tokyo, Japan

  2. 2

    St. Luke's College of Nursing, Maternal Infant Nursing and Midwifery, Akashi-cho, Chuo-ku, Tokyo, Japan

  3. 3

    Nagasaki University, Graduate School of Biomedical Sciences, Division of Reproductive Health-International Health Nursing, Nagasaki, Tokyo, Japan

  4. 4

    National Center for Child Health and Development, Department of Health Policy, Tokyo, Tokyo, Japan

*Rintaro Mori, Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, Tokyo, 166-0014, Japan. rintaromori@gmail.com.

Publication History

  1. Publication Status: New
  2. Published Online: 26 NOV 2013

SEARCH

 
Characteristics of included studies [ordered by study ID]
Andersen 1998

MethodsA prospective, double-blind, randomised trial using blinded envelopes. Individual randomisation was stratified in blocks of 50.


ParticipantsSetting: The Department of Obstetrics and Gynecology, Kolding Hospital, Kolding, Denmark.

Participants: 217 pregnant women admitted between November 16, 1992 and December 4, 1993. 

Inclusion criteria: women with a single pregnancy and no evidence of maternal pregnancy complications and no contraindications for methylergometrine (hypertension and vascular diseases).

Exclusion criteria: not mentioned.


InterventionsExperimental intervention: IV methylergometrine (Methergin (R) Sandoz, 0.2 mg) after delivery of the placenta and oral Methergin(R) (0.125 mg) tablet 3 times a day for 3 days.

Control/comparison intervention: IV methylergometrine (Methergin (R) Sandoz, 0.2 mg) after delivery of the placenta and placebo 3 times a day for 3 days.


OutcomesPrimary outcome: the amount of lochia (g) during the first 72 hours of puerperium. Lochia was measured by collecting and weighing sanitary towels.

Secondary outcomes: postpartum haemorrhage (loss of more than 600 mL/day) and curettage underwent the 10th day after delivery to remove placental fragments; postpartum endometritis diagnosed when body temperature was 38.0 degrees Celsius or higher on 2 readings in an 8-hour interval and there was uterine tenderness, foul-smelling lochia and no other apparent cause of fever; paracetamol consumption on request (g); length of hospital stay (days).


NotesThis study did not report details of other interventions for prevention of bleeding. We requested from the first author of the study further information about the random sequence generation process and prespecified outcomes, but received no reply.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskQuote: "Randomisation, using blinded envelopes, was stratified in blocks of 50".

Comment: insufficient information about the sequence generation process to permit judgement of "Yes" or "No". We inquired with the first author of the study about the random sequence generation process and prespecified outcomes, but received no reply.

Allocation concealment (selection bias)Unclear riskQuote: "Randomisation, using blinded envelopes, was stratified in blocks of 50".

Comment: insufficient information to permit judgement of "Yes" or "No" as the method of concealment is not described. The absence of adequate allocation concealment can lead to selection bias because the envelope method was used for randomisation and there was no information about how the envelopes were managed.

Blinding of participants and personnel (performance bias)
All outcomes
Low riskQuote: "A prospective double-blind randomised trial". "Each woman received 0.2 mg methylergometrine (Methergin (R) Sandoz) intravenously after delivery of the placenta and was randomised to either tabl. Methergin(R) 0.125 mg or placebo."

Comment: blinded.

Participant: low risk of bias.

Clinician (Caregiver): low risk of bias.

Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskComment: insufficient information to permit judgement of "Yes" or "No" as the blinding method for outcome assessors is not described.

Outcome assessor: unclear risk of bias.

Incomplete outcome data (attrition bias)
All outcomes
Low riskQuote: "During the study period 111 women were randomised to the methylergometrine group. Four women in this group were excluded: one because of hypertension; one wished to go home early; two forgot to take their tablets". "A total of 106 women were randomised to the placebo group. Two women in this group were excluded: one forgot to collect sanitary towels and one wished to go home early."

Comment: according to the reasons for exclusion, there is no evidence of attrition bias. Each proportion of missing outcomes was, however, 3.8% in the methylergometrine group and 1.9% in the placebo group. Those proportions of missing outcomes compared with observed events risk, e.g. incidence of endometritis was 2 (1.87%) in the treatment group and 1 (0.96%) in the placebo group, may be enough to have a clinically relevant impact on the intervention effect estimate, but it is not unclear. The analysis was not intention-to-treat and the data were not able to be re-included.

Selective reporting (reporting bias)Unclear riskInsufficient information to permit judgement of "Yes" or "No" as information of expected outcomes prespecified for the study were not described.

Other biasUnclear riskThere was a difference in the need for oxytocin augmentation of labour between the participants in the intervention group (20%) and those in the control group (30%). Other baseline characteristics were quite similar.

Arabin 1986

MethodsA prospective, randomised, placebo-controlled trial.


ParticipantsSetting: University Hospital, Frauenklinik Heidelberg, Germany.

Participants: 880.

Inclusion criteria: not reported.

Quote: "The sample used in this study contained 880 women." "The aim of the prospective randomised trial reported here was to study in detail the effects of the routine administration of Methergin, with particular reference to uterine involution, puerperal morbidity and lactation".

Comment: according to the study aim quoted above, the intervention of interest of the study was the routine administration of methylergometrine. Therefore, we inferred that participants of the study were mainly women with normal delivery.

Exclusion criteria: not reported.

Quote: "The sample used in this study contained 880 women".


InterventionsExperimental intervention: 1 tablet of Methergin (0.125 mg methylergometrine maleate) 3 times a day for 4 weeks.

Control/comparison intervention: placebo 3 times a day for 4 weeks.


OutcomesMain outcomes

Uterine involution

The height of the fundus between day 2 and day 5 postpartum

The size of the uterus measured using ultrasound at 4 weeks postpartum

Quantity of the lochia within 4 weeks postpartum

The number of women with the duration of lochia shorter than 4 weeks

Postpartum haemorrhage (blood loss of 500 mL or more over 2 days or more during the first week after birth)

Puerperal morbidity

Intensity of the after-pains on a scale from 0-36

Incidence of infection with lochiostasis and endometritis between day 1 and day 10 postpartum

Allergic reactions to Methergin(R)

Lactation

Daily quantity of milk produced


NotesAuthors did not report details of other interventions for prevention of bleeding.

There were 85 caesarean section cases in the Methergin group and 77 in the placebo group.

We inquired with the first author of the study about the prespecified outcomes, and received a satisfactory answer. The author verified that the definition of PPH was blood loss of 500 mL or more and the observational period was at least 2 days during the first week after birth.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskQuote: "The aim of the prospective randomised trial reported here was to study in detail the effects of routine administration of Methergin, with particular reference to uterine involution, puerperal morbidity and lactation".

Comment: no information was provided on how random allocation was performed. We inquired with the first author of the study about the random sequence generation process and received a satisfactory answer. The author verified that they performed the block randomisation using a computer-generated sequence number.

Allocation concealment (selection bias)Unclear riskQuote: "The aim of the prospective randomised trial reported here was to study in detail the effects of routine administration of Methergin, with particular reference to uterine involution, puerperal morbidity and lactation".

Comment: no information was provided on how random allocation was performed. We inquired with the first author of the study about the concealment process, but we received no satisfactory answers.

Blinding of participants and personnel (performance bias)
All outcomes
Low riskQuote: "The control group of 436 mothers were given a placebo three times daily for the same period of time".

Comment: blinded.

Participant: low risk of bias.

Clinician (Caregiver): low risk of bias.

Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskNo information was provided on how outcome assessors were blinded.

Incomplete outcome data (attrition bias)
All outcomes
Low riskThe number of participants lost to follow-up varied across outcomes. All participants who enrolled in the study were accounted for in the prespecified outcome measure PPH. Although there was no mention of the exclusion after randomisation and intention-to-treat analysis, the study appeared to be free of attrition bias.

Selective reporting (reporting bias)Low riskInsufficient information to permit judgement of "Yes" or "No" as information of expected outcomes prespecified for the study were not described. We inquired with the first author of the study about the prespecified outcomes, and received a satisfactory answer.

Other biasUnclear riskBaseline characteristics, i.e. maternal age, parity and birthweight of the baby were reported in the study; however, frequency of the labour induction, augmentation, and breast-feeding were not reported. Inference on prophylactic effect of Methergin may be confounded by such baseline imbalances if not properly accounted for. Furthermore, the definition of 'postpartum haemorrhage' in the study was not reported. We inquired with the first author of the study about the prespecified outcomes, and received a satisfactory answer. The author verified that the definition of PPH was blood loss of 500 mL or more and the observational period was at least 2 days during the first week after birth.

Jolivet 1978

MethodsA randomised study.


ParticipantsSetting: not reported.

Participants: 58.

Inclusion criteria: women who had given birth at full term to a healthy child and then initiated breast feeding.

Exclusion criteria: not reported.


InterventionsExperimental intervention: an intramuscular injection of 0.2 mg methylergometrine immediately after delivery, followed by 1.0 mg ergotamine tartrate tablets 3 times a day for the first 6 days postpartum.

Control/comparison intervention: no rye ergot derivatives, either at delivery or in the following 6 days.


OutcomesAverage birthweight, infant weight gain during the first 6 days postpartum (breast-fed infants) and quantity of milk consumed in 24 hours during the first 5 days after birth.


NotesThe aim of the trial was to study the possible effects of ergot derivatives on lactation. The outcome measures prespecified in the study were average birthweight, infant weight gain during the first 6 days postpartum (for breast-fed infants) and quantity of milk consumed in 24 hours during the first 5 days after birth. This study did not explore the effects of the intervention on postpartum haemorrhage. Hence, we did not ask the author about the other outcomes.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskQuote: "Two groups were set up randomly".

Comment: no information was provided on how random allocation was performed.

Allocation concealment (selection bias)Unclear riskQuote: "Two groups were set up randomly".

Comment: no information was provided on how random allocation was performed.

Blinding of participants and personnel (performance bias)
All outcomes
High riskQuote: 28 women did not receive rye ergot derivatives.

Comment: not blinded.

Participant: high risk of bias.

Clinician (Caregiver): high risk of bias.

Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskNo information was provided on how the outcome assessors were blinded.

Incomplete outcome data (attrition bias)
All outcomes
Unclear riskNo information was provided on the number of participants lost to follow-up.

Selective reporting (reporting bias)Unclear riskQuote: "The aim of the present trial is to study the possible effects on lactation of using rye ergot alkaloids in the first days post partum".

The outcome measures prespecified in the methods of the study were average birthweight, infant weight gain during the first 6 days postpartum (for breast-fed infants) and quantity of milk consumed in 24 hours during the first 5 days after birth. Outcomes of interest for this review were not available.

Other biasUnclear riskAuthors did not report any details of interventions except for methylergometrine and ergotamine tartrate.

Klug 1983

MethodsA quasi-randomised controlled study.


ParticipantsSetting: Austria.

Participants: 140.

Inclusion criteria: postpartum women who had given birth at full term.

Exclusion criteria: not reported.


InterventionsExperimental intervention: 0.125 mg methylergometrine (Methergin) orally 3 times a day for 8 days.

Control/comparison intervention: no medication nor methylergometrine.


OutcomesLength of the uterus in mm, duration of hospital stay, puerperal morbidity related to infections (unexplained febrile response, expulsion of matter and/or foetid lochia with fever, need for antibiotic treatment, and foetid lochia only) at day 8 postpartum.


NotesWe asked the author about the randomisation methods. According to the author's reply, alternate allocation in a consecutive series of 140 postpartum women was used. Therefore, we defined the study as a quasi-randomised trial. The outcome measures prespecified in the methods of the study were the length of the uterus, the duration of the hospital stay, puerperal morbidity related to infections (unexplained febrile response, expulsion of matter and/or foetid lochia with fever, need for antibiotic treatment, and foetid lochia only) at day 8 postpartum. According to the study title "Influence of methyl-ergometrine on early puerperal involution of the uterus" and the prespecified outcomes, we concluded that the study did not explore the effects of methylergometrine on postpartum haemorrhage. Hence, we did not ask the author about the other outcomes.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskDescription: alternate allocation in a consecutive series was performed.

Comment: quasi-randomisation.

Allocation concealment (selection bias)Unclear riskComment: no information was provided on how alternate allocation was performed.

Blinding of participants and personnel (performance bias)
All outcomes
High riskQuote: 71 women were not given the medication nor any methylergometrine.

Comment: not blinded.

Participant: high risk of bias.

Clinician (Caregiver): high risk of bias.

Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskNo information was provided on how the outcome assessors were blinded.

Incomplete outcome data (attrition bias)
All outcomes
Low riskDescription: the number of analysed participants was the same as the number of participants allocated.

Comment: although there was no mention of the number of participants lost to follow-up, the study appeared to be free of attrition bias.

Selective reporting (reporting bias)Unclear riskOutcomes of interest of this review were not available.

Other biasUnclear riskQuote: a group of 69 puerperal women, which is matched with an untreated group of 71.

Comment: baseline characteristics might be similar in 2 groups.

Ushiroyama 2003

MethodsA prospective, randomised, open-label, trial.


ParticipantsSetting: Osaka Medical College Hospital and its affiliated clinics, Japan.

Participants: 171.

Inclusion criteria: women who had spontaneous labour pain followed by a normal delivery.

Exclusion criteria: women who had complicated pregnancy symptoms requiring special management such as breech presentation, gestational toxicosis, diabetes mellitus, multiple conception, or premature rupture of the membrane.


InterventionsExperimental intervention: Ergometrine (methylergometrine maleate) at an oral dose of 0.375 mg, on the day of delivery.

Control/Comparison intervention: Kyuki-chouketsu-in granules (Kanebo Pharmaceutical Co., Ltd., Tokyo, Japan) at an oral dose of 6.0 g/day (2.0 g 3 times a day) on the day of delivery.


OutcomesMain outcomes

Height of the uterine fundus (cm) on days 1 and 6 postpartum

Blood haemoglobin concentration on days 1 and 6 postpartum

Axillary temperature at 6:00 am on days 1 and 6 postpartum

Others: plasma total protein, albumin, glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), alkaline phosphatase, leucine aminopeptidase (LAP), total cholesterol, triglyceride and C-reactive protein (CRP)


NotesAll women enrolled in the trial received cefditoren pivoxil, an antimicrobial agent commonly administered to puerperal women, at a dose of 300 mg/day, and serapeptase, an anti-inflammatory enzyme preparation, at a dose of 30 mg/day. Authors did not report details of other interventions for prevention of bleeding.

We requested the study author, Dr Ushiroyama, to provide further information about blood haemoglobin concentrations, and it was provided.

We found that the blood haemoglobin concentrations presented in Table 3 are inconsistent with those in the text. We contacted one of the authors, Dr Ushiroyama, who verified that the blood haemoglobin concentrations written in the text were correct.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskQuote: "Using the envelope method, the women were randomly assigned to a group of 85 women receiving Kyuki-chouketsu-in or a group of 86 women receiving ergometrine".

Comment: insufficient information about the sequence generation process because no information was provided on how the envelopes for random allocation were prepared and managed.

Allocation concealment (selection bias)Unclear riskQuote: "Using the envelope method, the women were randomly assigned to a group of 85 women receiving Kyuki-chouketsu-in or a group of 86 women receiving ergometrine".

Comment: insufficient information to permit judgement of "Yes" or "No" as the method of concealment was not described. The absence of adequate allocation concealment could lead to selection bias when the envelope method was used for randomisation because there was no information about how the envelopes were managed.

Blinding of participants and personnel (performance bias)
All outcomes
High riskQuote: "The women were randomly assigned to a group of 85 women receiving Kyuki-chouketsu-in (Kanebo Pharmaceutical Co., Ltd., Tokyo, Japan) granules at an oral dose of 6.0 g/day (2.0 g three times a day), on the day of delivery, or a group of 86 women receiving ergometrine (methylergometrine maleate) at an oral dose of 0.375 mg/day on the day of delivery".

Comment: not blinded.

Participant: high risk of bias.

Clinician (Caregiver): high risk of bias.

Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskNo information was provided on how outcome assessors were blinded.

Incomplete outcome data (attrition bias)
All outcomes
Unclear riskIt was not possible to assess the completeness of the follow-up as the number of outcome measured participants was not mentioned.

Selective reporting (reporting bias)Low riskQuote: (in the 'protocol section') Evaluation was performed between days 1 and 6 postpartum to determine the height of the uterine fundus, axillary temperature at 6:00 am and blood sample were obtained to determine blood haemoglobin, plasma total protein, albumin, glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), alkaline phosphatase, leucine aminopeptidase (LAP), total cholesterol, triglyceride and C-reactive protein (CRP).

Comment: no selective reporting in this study was suspected as all of these outcomes were reported.

Other biasUnclear riskBaseline blood haemoglobin concentrations were not available because the data of the blood haemoglobin on the day before delivery were not shown. Therefore, it was not possible to assess differences in the baseline haemoglobin concentrations between the 2 study groups.

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Del Pozo 197520 postpartum women were enrolled in the study and were divided into 2 groups: 10 women were treated with oral methylergometrine (0.2 mg) 3 times a day for 7 days, and the remaining 10 women received no medication. We asked one of the authors for further information on the points below, but we received no reply.

・Randomisation methods

・Intervention methods

・Participant inclusion/exclusion criteria

Vogel 2004The study is a prospective open-labelled randomised trial. Treatments were allocated in a computer-generated random sequence with sealed opaque envelopes to either 0.25 mg oral methylergometrine or 0.2 mg misoprostol orally. Eligible patients were healthy, lactating women with the postpartum complication of uterine atony (putrid lochia, soft uterus < 3 fingerbreadth below the umbilicus) who were normally treated with methylergometrine on postpartum days 3 through 6. The eligibility criteria of the participants did not meet the review criteria. Furthermore, the outcome data did not meet the review inclusion criteria as the outcome measures prespecified in the methods of the study were milk and maternal plasma levels of misoprostol and methylergometrine.

 
Characteristics of studies awaiting assessment [ordered by study ID]
Arabin 1982

MethodsA prospective randomised study.

ParticipantsMothers who gave birth vaginally or underwent caesarean section.

InterventionsMethylergometrine (0.125 mg/tablet), 3 tablets/day for 4 weeks.

OutcomesUterine involution, frequency of puerperal infection, reddish lochia, amount of breastfeeding, and consultation a doctor because of severe bleeding.

NotesThis is an abstract that was presented in the congress proceedings of the 8th European Congress of Perinatal Medicine, Brussels, Belgium, September 7-10, 1982. A prospective, randomised study was performed at 1 clinic and included 860 mothers: 438 who were treated with methylergometrine (0.125 mg/tablet, 3 tablets/day) for 4 weeks, and 422 who did not receive treatment. The methods, however, were not described in detail. Furthermore, there was no information on baseline characteristics and follow-up rate: only outcome data were available. According to the information reported in the abstract, this appeared to be the same study as Arabin 1986. We approached one of the authors of the study to verify this information, but did not receive a reply.

Grünberger 1983

MethodsA prospective, randomised trial using consecutively numbered sealed opaque envelopes.

ParticipantsUncomplicated pregnancies with spontaneous term delivery.

Interventions0.125 mg methylergometrine or 0.5 mg prostaglandin-E2, 3 times a day from day 1 to day 5 postpartum.

OutcomesUterine involution (amount, intensity and painfulness of contractions, and fundal height), lochia flow, bowel function, pulse, blood pressure, temperature, onset of lactation and amount of breast milk produced.

NotesThe study is self-described as a prospective randomised trial using consecutively numbered sealed opaque envelopes, in which totally 80 parturients were allocated to either 0.125 mg methylergometrine 3 times a day or to 0.5 mg prostaglandin-E2 3 times a day from day 1 to day 5 postpartum. The outcome measures in the study were uterine involution (amount, intensity and painfulness of contractions, and fundal height), lochia flow, bowel function, pulse, blood pressure, temperature, onset of lactation and amount of breast milk produced. 3 of the outcomes, lochia flow, blood pressure, and temperature, met the criteria for review inclusion. However, no data on blood pressure and temperature were reported, and lochia flow was determined and given as scores for which no interpretation or reference was provided. We contacted the author of the study regarding the data on blood pressure and temperature but did not receive a reply.

 
Characteristics of ongoing studies [ordered by study ID]
Oberbaum 2005

Trial name or titleThe effect of the homeopathic remedies Arnica montana and Bellis perennis on mild postpartum bleeding. A randomised, double-blind, placebo-controlled study.

MethodsA double-blind trial in which participants were randomised into 3 intervention arms using block randomisation lists.

ParticipantsWomen aged 20-35, at 37-43 weeks' gestation, singleton, scheduled for spontaneous vaginal delivery.

Interventions(1) Arnica montana and Bellis perennis, both at a dilution of 10-6 in a stem solution; (2) Arnica and Bellis, both at a dilution of 10-60; and (3) identical placebos.

OutcomesMean haemoglobin levels at 48 and 72 hours following delivery.

Starting dateFebruary 2003.

Contact informationCorresponding author: Menachem Oberbaum; E-mail address: oberbaum@szmc.org.il; Tel: +972-2-6666-395; Fax: +972-2-6666-975.

Notes1 report presents preliminary results based on the interim analysis of an ongoing clinical trial, in which the total sample size was calculated to be 210 eligible patients. Patients were randomly allocated in a double-blinded manner using block randomisation lists into 3 groups: (1) Arnica montana and Bellis perennis, both in a dilution of 10-6 of the stem solution; (2) Arnica montana and Bellis perennis, both in a dilution of 10-60; and (3) identical placebos. The interim analysis was based on the results of the first 45 patients who were enrolled in the study. The reported outcome data were the mean haemoglobin levels at 48 and 72 hours following delivery. There was no information on blood loss.

The other report is the abstract of the ongoing study and was reported in 'Abstracts of the 12th Annual Symposium on Complementary Health Care 19th –21st September 2005, Exeter, UK'.

 
Comparison 1. Oral methylergometrine versus placebo

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 PPH (blood loss of 500 mL or more over the period of observation)21097Risk Ratio (M-H, Random, 95% CI)1.45 [0.39, 5.47]

 2 Amount of lochia during the first 72-hour of the puerperium (g) (outcome not prespecified)1211Mean Difference (IV, Fixed, 95% CI)-25.0 [-69.79, 19.79]

 3 Amount of lochia by 4 weeks postpartum (g) (outcome not prespecified)1880Mean Difference (IV, Fixed, 95% CI)-7.0 [-23.99, 9.99]

 4 Duration of lochia of more than 4 weeks (outcome not prespecified)1880Risk Ratio (M-H, Fixed, 95% CI)1.26 [1.13, 1.40]

 5 Endometritis (outcome not prespecified)21097Risk Ratio (M-H, Fixed, 95% CI)1.60 [0.76, 3.36]

 6 Pain requiring analgesia (requests for paracetamol) (outcome not prespecified)1217Risk Ratio (M-H, Fixed, 95% CI)1.19 [0.87, 1.62]

 
Comparison 2. Oral methylergometrine versus oral Kyuki-chouketsu-in

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Blood haemoglobin concentration at day 1 postpartum (g/dL)1171Mean Difference (IV, Fixed, 95% CI)0.5 [0.11, 0.89]