“…56 Table 1 demonstrates the results of the appraisal, finding all 41 studies to be detailed enough to be replicated, relevant to contemporary practice, and demonstrate adequately ascertained exposure (GSW) and coprimary outcomes (maternal and/or neonatal death). While 82% (34/41) of studies had adequate follow-up of surviving patient(s) until or beyond discharge, [4][5][6][7][8][12][13][14][15][16][17][18][19][20][23][24][25][27][28][29][30][31][32][33][34][35][36][38][39][40][41][42][43][44] few studies (6/41) with a clear selection method were limited to the case series and small registries in this review. 5,6,11,16,41,43 In the GRADE 57 assessment of our review based on observational studies, our certainty of evidence was downgraded due to risk of selection bias and upgraded as possible confounders not discussed in the studies (comorbidities, obstetric history, socioeconomic status, degree of education, global variation in standards of care, etc.)…”