Objectives: to evaluate the effectiveness of uterine tamponade devices for atonic refractory postpartum haemorrhage (PPH) after vaginal birth, and the effect of including uterine tamponade devices in institutional protocols. Search strategy: databases in PubMed, EMBASE, CINAHL, LILACS and POPLINE. Study selection: randomised and non-randomised comparative studies. Outcomes: composite outcome including surgical interventions (artery ligations, uterine compressive sutures or hysterectomy) or maternal death, and hysterectomy. Results: all four included studies were at high risk of bias. The certainty of evidence rated as very low to low. One randomised study measured the effect of the the condom-catheter balloon compared to standard care and found unclear results for the composite outcome (RR 2.33, 95%CI 0.76-7.14) and hysterectomy (RR 4.14, 95%CI 0.48-35.93). Three comparative studies assessed the effect of including UBTs in institutional protocols. A stepped-wedge study suggested an increase in the composite outcome (RR 4.08, 95%CI 1.07-15.58), and unclear results for hysterectomy (RR 4.38, 95% CI 0.47-41.09) with the use of the condom-catheter or surgical glove balloon. One non-randomised study showed unclear effects on the composite outcome (RR 0.33, 95%CI 0.11-1.03) and hysterectomy (RR 0.49, 95%CI 0.04-5.38) after the inclusion of Bakri balloon. The second non-randomized study found unclear effects on the composite outcome (RR 0.95, 95%CI 0.32-2.81) and hysterectomy (RR 1.84, 95%CI 0.44-7.69) after the inclusion of Ebb or Bakri balloon. Conclusions: the effect of uterine tamponade devices for the management of atonic refractory PPH after vaginal delivery is unclear, as is the role of the type of device and the setting.

Objective To compare the effectiveness and safety of dexamethasone versus betamethasone for preterm birth (registered in PROSPERO CRD42017078006). Search strategy We searched in MEDLINE, EMBASE, Cochrane Library, LILACS, Clinical Trials.gov, International Clinical Trials Registry Platform, reference lists and contacted field experts. Selection criteria, data collection and analysis Randomized controlled trials comparing any corticosteroids against each other or against placebo. Three researchers independently selected, extracted data and assessed the risk of bias of the included studies by using EROS and COVIDENCE software. We performed a pairwise meta-analysis and Bayesian network meta-analysis. Main results We included 45 trials (11227 women, 11878 infants). There was no important difference between corticosteroids in neonatal death (odds ratio[OR] 1.05; 95% confidence interval 0.62-1.84; moderate-certainty evidence[CE]), neurodevelopmental disability (OR 1.03; 0.80-1.33; moderate-CE), intraventricular haemorrhage (OR 1.04; 0.56-1.78); low-CE) and birthweight (+5.29 gr; -49.79 to 58.97; high-CE). Compared with betamethasone, dexamethasone may reduce chorioamnionitis (OR 0.70; 0.45-1.06; moderate-CE), foetal death (OR 0.81; 0.24-2.41; low-CE) while may increase puerperal sepsis (OR 2.04; 0.72-6.06; low-CE) and respiratory distress syndrome (OR 1.34; 0.96-2.11; moderate-CE), however, the confidence interval indicates both beneficial and detrimental effects. Conclusions We found no important difference on neonatal death, neurodevelopmental disability, intraventricular haemorrhage and birthweight between corticosteroids. Compared with betamethasone, dexamethasone may reduce chorioamnionitis and foetal death, but may increase endometritis/puerperal sepsis and respiratory distress syndrome. Further research is warranted to improve the certainty of evidence. Keywords preterm birth, antenatal corticosteroids, dexamethasone, betamethasone, systematic review, network meta-analysis

Objectives: to describe available uterine tamponade devices for the management of postpartum haemorrhage, and to evaluate its effectiveness as a treatment of refractory PPH. Search strategy: Databases searched included PubMed, EMBASE, CINAHL, LILACS and POPLINE. Study selection: To describe uterine tamponade devices any type of study was included; only randomised and non-randomised comparative studies were included to assess the effectiveness of uterine tamponade devices. Outcomes: The primary outcomes were: a composite outcome including surgical interventions or maternal death, and hysterectomy. Results: Twenty-four types of tamponade devices were identified. The Bakri and the condom-catheter balloon were the most frequently reported. One randomised controlled trial suggests non-significant increases in the composite outcome (RR 2.33, 95%CI 0.76-7.14) and hysterectomy (RR 4.14, 95%CI 0.48-35.93) associated with the condom-catheter balloon vs. no device. Another RCT suggests a non-significant reduction in the composite outcomes (RR 0.60; 95%CI 0.16-2.31) and hysterectomy (RR=0.5; 95%CI 0.05-5.25) with the Bakri balloon vs the condom-catheter balloon. A stepped-wedge study suggests an increase in the composite outcome (RR 4.08, 95%CI 1.07-15.58), and a non-significant increase in hysterectomies (RR 4.38, 95% CI 0.47-41.09) associated with the introduction of condom-catheter or surgical glove balloon into clinical settings. Conversely, non-randomised studies showed a non-statistically significant reduction (RR=0.61, 95%CI 0.27-1.40) in the composite outcome and no effect on hysterectomy associated with the use of the Bakri balloon. Conclusions: The effect of UBT for the management of atonic refractory PPH after vaginal delivery is unclear, as is the role of the type of device and the setting.