loading page

The Effect of Non-pharmacological Interventions on Blood Loss During and After Caesarean Section: a Systematic Review and Network Meta-analysis
  • +12
  • Elliott Taylor H,
  • Ella Marson J,
  • Salome Maswime,
  • Rema Ramakrishnan,
  • David Bishop,
  • Soha Sobhy,
  • Chian-Jia Eden Chiu,
  • Rowan Duys,
  • Akinyinka Omigbodun,
  • Kristopher Schwebler,
  • Karen van der Spuy,
  • Nicola Vickery,
  • Kokila Lakhoo,
  • Bruce Biccard M,
  • Leon du Toit
Elliott Taylor H
University of Oxford

Corresponding Author:elliott.taylor1@googlemail.com

Author Profile
Ella Marson J
University College London Faculty of Population Health Sciences
Author Profile
Salome Maswime
University of Cape Town Department of Surgery
Author Profile
Rema Ramakrishnan
University of Oxford
Author Profile
David Bishop
University of KwaZulu-Natal School of Clinical Medicine
Author Profile
Soha Sobhy
University of Birmingham School
Author Profile
Chian-Jia Eden Chiu
University of Cape Town Department of Anaesthesia and Perioperative Medicine
Author Profile
Rowan Duys
University of Cape Town Department of Anaesthesia and Perioperative Medicine
Author Profile
Akinyinka Omigbodun
University of Ibadan College of Medicine
Author Profile
Kristopher Schwebler
University of Washington Department of Anesthesiology & Pain Medicine
Author Profile
Karen van der Spuy
University of Cape Town Department of Anaesthesia and Perioperative Medicine
Author Profile
Nicola Vickery
Barts Health NHS Trust
Author Profile
Kokila Lakhoo
University of Oxford Nuffield Department of Surgical Sciences
Author Profile
Bruce Biccard M
University of Cape Town Department of Anaesthesia and Perioperative Medicine
Author Profile
Leon du Toit
University of Cape Town Department of Anaesthesia and Perioperative Medicine
Author Profile

Abstract

Background & Objective Blood loss during and after caesarean section is a key determinant of maternal mortality, especially in low- and middle-income countries. This systematic review aimed to identify effective non-pharmacological interventions for reducing blood loss during and after caesarean section. Search Strategy Multiple databases were searched from inception to December 2023. Selection Criteria Prospective studies of women undergoing caesarean section assessing non-pharmacological interventions reporting estimated blood loss and/or post-partum haemorrhage were included. Retrospective studies and study populations not representative of the general caesarean section cohort were excluded. A difference in blood loss of >250ml or a relative risk reduction in post-partum haemorrhage of >25% was considered clinically important. Data Collection and Analysis Data was double extracted. Network meta-analyses and conventional pairwise meta-analyses were performed where appropriate. Risk of bias was assessed using Cochrane RoB 2 or ROBINS-I tools. Main Results 97 studies were eligible for inclusion. 40 were synthesised in five distinct network meta-analyses (caesarean section surgical technique, placenta removal technique, timing of umbilical cord clamping, peritoneum closure and patient warming) and 36 in six pairwise meta-analyses (staple uterine incision, sharp versus blunt expansion of uterine incision, cervical dilatation, extra versus intra-abdominal uterine repair, suture material, and one versus two-layer uterine closure). None of the intervention groups were associated with a clinically important effect. Conclusions The published trials of non-pharmacological interventions on blood loss associated with caesarean section are inconclusive. There is a need for collaborative trials to identify effective and generalisable interventions. A key focus should be interventions that may be impactful in low resource settings where blood loss is the dominant determinant of maternal mortality related to caesarean section.
12 Dec 2024Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
24 Dec 2024Submission Checks Completed
24 Dec 2024Assigned to Editor
24 Dec 2024Review(s) Completed, Editorial Evaluation Pending
30 Dec 2024Reviewer(s) Assigned