Table 6Comparison 2. Trials comparing different caesarean birth techniques

Quality assessmentNumber of womenEffectQualityImportance
Number of studiesDesignRisk of biasInconsistencyIndirectnessImprecisionOther considerationsSingle-layer uterine closure (intervention)Double-layer uterine closure (control)Relative (95% CI)Absolute
Blood transfusion
3 (Chitra 2004, Nabhan 2008, Poonam 2006)Randomised trialsVery serious1No serious inconsistencyVery serious2No serious imprecisionNone

3/662

(0.45%)

20/662

(3%)

RR 0.19 (0.07 to 0.55)24 fewer per 1000 (from 14 fewer to 28 fewer)VERY LOWCRITICAL
Antibiotics required (unspecified reason)
2 (Darj 1999, Xavier 2005)Randomised trialsVery serious1No serious inconsistencyVery serious2No serious imprecisionNone

73/102

(71.6%)

64/94

(68.1%)

RR 1.02 (0.94 to 1.11)14 more per 1000 (from 41 fewer to 75 more)VERY LOWIMPORTANT
Antibiotics for wound infection (and wound sepsis) (pooled all CS)
3 (Nabhan 2008, Poonam 2006, Ohel 1996)Randomised trialsVery serious3Serious4Very serious2Very serious5None

15/662

(2.3%)

23/662

(3.5%)

RR 0.77 (0.27 to 2.24)8 fewer per 1000 (from 25 fewer to 43 more)VERY LOWIMPORTANT
Antibiotics for wound infection (and wound sepsis) (Subgroup analysis, first CS only)
2 (Nabhan 2008, Poonam 2006)Randomised trialsVery serious6Very serious7Very serious2Very serious5None

7/500

(1.4%)

16/500

(3.2%)

RR 0.51 (0.05 to 5.43)16 fewer per 1000 (from 30 fewer to 142 more)VERY LOWIMPORTANT
Antibiotics for wound infection (and wound sepsis) (Subgroup analysis, repeat CS only)
1 (Nabhan 2008)Randomised trialsSerious8No serious inconsistencyVery serious2Very serious5None

4/62

(6.5%)

4/62

(6.5%)

RR 1 (0.26 to 3.82)0 fewer per 1000 (from 48 fewer to 182 more)VERY LOWIMPORTANT
1

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

2

The quality of the evidence was downgraded by 2 levels for indirectness as the comparison also examined uterine incision, exteriorisation of the uterus, peritoneal closure, skin closure, and suture material

3

The quality of the evidence was downgraded by 2 levels for risk of bias as the outcome had high risk of performance bias, and selection bias

4

The quality of the evidence was downgraded by 1 level for inconsistency as heterogeneity was high (I2=55%, random effects model)

5

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)

6

The quality of the evidence was downgraded by 2 levels for risk of bias as the outcome had high risk of performance bias in more than 1 study

7

The quality of the evidence was downgraded by 2 levels for inconsistency as heterogeneity was high (I2=81%, random effects model)

8

The quality of the evidence was downgraded by 1 level for risk of bias as the outcome had high risk of performance bias in 1 study

From: Techniques to close the uterus at caesarean birth

Cover of Techniques to close the uterus at caesarean birth
Techniques to close the uterus at caesarean birth: Caesarean birth: Evidence review D.
NICE Guideline, No. 192.
National Guideline Alliance (UK).
Copyright © NICE 2021.

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