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Evidence found and GRADE certainty

4,776 questions · 7,311 findings · 959 reviews · Headline outcomes only

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No studies found 1,498 · 20.5%GRADE not reported 303 · 4.1%Very low 1,839 · 25.2%Low 1,991 · 27.2%Moderate 1,277 · 17.5%High 403 · 5.5%

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Handheld vacuum vs any vacuum cup

Low umbilical artery pH (< 7.2 or as defined by trial authors) · Women in the second stage of labour, requiring an assisted vaginal birth

Handheld vacuum showed no clear difference in low umbilical artery pH (< 7.2 or as defined by trial authors) compared with any vacuum cup (low certainty).

1 finding from 1 review

Any type of forceps vs any vacuum cup

Low Apgar score · Women in the second stage of labour, requiring an assisted vaginal birth

Any type of forceps showed no clear difference in low Apgar score at 5 minutes (< 7 or as defined by trial authors) compared with any type of vacuum cup (moderate certainty).

1 finding from 1 review

Any type of forceps vs any vacuum cup

Low umbilical artery pH (< 7.2 or as defined by trial authors) · Women in the second stage of labour, requiring an assisted vaginal birth

Any type of forceps showed no clear difference in low umbilical artery pH (< 7.2 or as defined by trial authors) compared with any type of vacuum cup (low certainty).

1 finding from 1 review

Endometrial injury vs control

Miscarriage per woman randomised (studies at low risk of selection bias and other bias) · women undergoing assisted reproduction

Endometrial injury showed no clear difference in miscarriage per woman randomised (studies at low risk of selection… compared with control (moderate certainty).

1 finding from 1 review