| Quality assessment | Number of women | Effect | Quality | Importance | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Number of studies | Design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | Single-layer uterine closure (intervention) | Double-layer uterine closure (control) | Relative (95% CI) | Absolute | ||
| Blood transfusion | ||||||||||||
| 3 (Brocklehurst 2010, CORONIS, Hauth/Chapman) | Randomised trials | Very serious1 | No serious inconsistency | No serious indirectness | Serious2 | None |
139/6579 (2.1%) |
149/6592 (2.3%) | RR 0.94 (0.74 to 1.18) | 1 fewer per 1000 (from 6 fewer to 4 more) | VERY LOW | CRITICAL |
| Further operative proceduresa | ||||||||||||
| 1 (CORONIS) | Randomised trials | Very serious3 | No serious inconsistency | No serious indirectness | Serious2 | None |
74/4639 (1.6%) |
87/4647 (1.9%) | RR 0.85 (0.63 to 1.16) | 3 fewer per 1000 (from 7 fewer to 3 more) | VERY LOW | CRITICAL |
| Further operative procedures on wound | ||||||||||||
| 1 (CORONIS) | Randomised trials | Very serious3 | No serious inconsistency | No serious indirectness | Very serious4 | None |
30/4639 (0.65%) |
38/4647 (0.82%) | POR 0.79 (0.49 to 1.27) | 2 fewer per 1000 (from 4 fewer to 2 more) | VERY LOW | CRITICAL |
| Uterine rupture in subsequent pregnancy | ||||||||||||
| 1 (CORONIS) | Randomised trials | Very serious3 | No serious inconsistency | No serious indirectness | Very serious4 | None |
1/1610 (0.06%) |
2/1624 (0.12%) | POR 0.52 (0.05 to 4.98) | 1 fewer per 1000 (from 1 fewer to 5 more) | VERY LOW | CRITICAL |
| Uterine scar dehiscence in subsequent pregnancy | ||||||||||||
| 2 (CORONIS, Hauth/Chapman) | Randomised trials | Very serious5 | No serious inconsistency | No serious indirectness | Very serious4 | None |
5/1679 (0.3%) |
2/1699 (0.12%) | POR 2.40 (0.55 to 10.58) | 2 more per 1000 (from 1 fewer to 11 more) | VERY LOW | CRITICAL |
| Antibiotics for wound infection or wound sepsis | ||||||||||||
| 5 (Brocklehurst 2010, El-Gharib 2013, Yasmin 2011, CORONIS, Sood 2005) | Randomised trials | Very serious6 | No serious inconsistency | No serious indirectness | No serious imprecision | None |
548/6329 (8.7%) |
582/6384 (9.1%) | RR 0.95 (0.85 to 1.06) | 5 fewer per 1000 (from 14 fewer to 5 more) | LOW | IMPORTANT |
| Antibiotics for febrile morbidity | ||||||||||||
| 2 (Brocklehurst 2010, CORONIS) | Randomised trials | Very serious3 | No serious inconsistency | No serious indirectness | Very serious4 | None |
59/6122 (0.96%) |
58/6143 (0.94%) | POR 1.02 (0.71 to 1.47) | 0 more per 1000 (from 3 fewer to 4 more) | VERY LOW | IMPORTANT |
| Antibiotics for endometritis | ||||||||||||
| 2 (CORONIS, Hauth/Chapman) | Randomised trials | Very serious5 | No serious inconsistency | No serious indirectness | Serious7 | None |
121/5096 (2.4%) |
99/5096 (1.9%) | RR 1.21 (0.94 to 1.55) | 4 more per 1000 (from 1 fewer to 11 more) | VERY LOW | IMPORTANT |
| Morbidly adherent placenta in subsequent pregnancy | ||||||||||||
| 1 (CORONIS) | Randomised trials | Very serious3 | No serious inconsistency | No serious indirectness | Very serious4 | None |
0/1609 (0%) |
2/1624 (0.12%) | POR 0.14 (0.01 to 2.18) | 1 fewer per 1000 (from 1 fewer to 1 more) | VERY LOW | IMPORTANT |
| Hysterectomy in 6 weeks postpartum in subsequent pregnancy | ||||||||||||
| 1 (CORONIS) | Randomised trials | Very serious3 | No serious inconsistency | No serious indirectness | Very serious4 | None |
1/1610 (0.06%) |
1/1624 (0.06%) | POR 1.01 (0.06 to 16.13) | 0 more per 1000 (from 1 fewer to 9 more) | VERY LOW | IMPORTANT |
| C-sections in subsequent pregnancy | ||||||||||||
| 2 (CORONIS, Hauth/Chapman) | Randomised trials | Very serious5 | No serious inconsistency | No serious indirectness | No serious imprecision | None |
1343/1700 (79%) |
1380/1721 (80.2%) | RR 0.98 (0.95 to 1.02) | 16 fewer per 1000 (from 40 fewer to 16 more) | LOW | IMPORTANT |
Includes any operative procedures on caesarean wound, curettage, laparotomy, artery ligation, brace suture, and hysterectomy.
The quality of the evidence was downgraded by 2 levels for risk of bias as the outcome had high risk of performance bias, and attrition bias
The quality of the evidence was downgraded by 1 level for imprecision as the 95%CI crosses the lower boundary of the default MID threshold (0.80)
The quality of the evidence was downgraded by 2 levels for risk of bias as the outcome had high risk of performance bias, and detection bias
The quality of the evidence was downgraded by 2 levels for imprecision as the 95%CI crosses the upper and lower boundaries of the default MID thresholds (0.80 and 1.25)
The quality of the evidence was downgraded by 2 levels for risk of bias as the outcome had high risk of performance bias, detection bias, and attrition bias
The quality of the evidence was downgraded by 2 levels for risk of bias as the outcome had high risk of performance bias, detection bias, and selection bias
The quality of the evidence was downgraded by 1 level for imprecision as the 95%CI crosses the upper boundary of the default MID threshold (1.25)
From: Techniques to close the uterus at caesarean birth
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