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Delgado A, Amorim MM, Oliveira ADAP, Souza Amorim KC, Selva MW, Silva YE, Lemos A, Katz L. Active pelvic movements on a Swiss ball reduced labour duration, pain, fatigue and anxiety in parturient women: a randomised trial. J Physiother 2024; 70:25-32. [PMID: 38036399 DOI: 10.1016/j.jphys.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/30/2023] [Accepted: 11/01/2023] [Indexed: 12/02/2023] Open
Abstract
QUESTION How much do active pelvic movements on a Swiss ball during labour affect maternal and neonatal outcomes? METHOD A randomised trial with concealed allocation, blinded assessors and intention-to-treat analysis. PARTICIPANTS Two-hundred parturient women. INTERVENTION The experimental group performed pelvic anteversion and retroversion, lateral pelvic tilts and circular hip movements according to individual obstetric evaluation (foetal station and position, cervical dilatation and the presence of early pushing urge) on a Swiss ball. The control group received usual care. Both groups were permitted to walk and shower. OUTCOME MEASURES The primary outcome was the duration of the first stage of labour. The secondary outcomes were the duration of the second stage of labour, pain intensity, delivery mode, medication use, local swelling, fatigue, anxiety, satisfaction and neonatal outcomes. RESULTS The experimental intervention reduced the duration of labour by 179 minutes (95% CI 146 to 213) in stage one and 19 minutes (95% CI 13 to 25) in stage two. It decreased pain by approximately 2 points (95% CI 2 to 2) on a 0-to-10 scale at 30, 60 and 90 minutes. It reduced the risk of a caesarean section (ARR 0.14, 95% CI 0.03 to 0.25; NNT 7, 95% CI 4 to 32) and vulvar swelling (ARR 0.11, 95% CI 0.03 to 0.19; NNT 9, 95% CI 5 to 31). It reduced fatigue by 18 points (95% CI 16 to 21) on a 15-to-75-point scale and anxiety by 9 points (95% CI 8 to 11) on an 18-to-72-point scale. Other effects were negligible or unclear. CONCLUSION Active pelvic movements on a Swiss ball during labour reduced the duration of labour, pain intensity, and maternal fatigue and anxiety; they also lowered the risk of caesarean section and vulvar swelling. Several effects exceeded the smallest worthwhile effect. REGISTRATION NCT04124835.
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Affiliation(s)
- Alexandre Delgado
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil.
| | - Melania M Amorim
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil; Medical Academic Unit, Federal University of Campina Grande, Campina Grande, Brazil
| | | | | | | | | | - Andrea Lemos
- Physical Therapy Department, Universidade Federal de Pernambuco, Recife, Brazil
| | - Leila Katz
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil
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DURMUŞ A, ERYILMAZ G. Effects of Heat and Massage Applications to the Lumbosacral Area on Duration of Delivery and Perception of Labor Pain: A Randomized Controlled Experimental Trial. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2022. [DOI: 10.33808/clinexphealthsci.1025304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Objective: This study was carried out to determine the effects of massage and hot-pack applications in the first stage of labor on perceptions of labor pain and duration of delivery.
Methods: This randomized controlled experimental trial was conducted in an obstetrics and pediatrics hospital. The research sample comprised 120 pregnant women, 40 of whom were in the massage group, 40 of whom were in the hot-pack application group, and 40 of whom were in the control group. Patient identification forms, labor process monitoring forms, and a visual analogue scale (VAS) were used to collect data.
Results: It was determined that the massage and hot-pack applications shortened the durations of the active and transition phases of labor. The massage and hot-pack applications also reduced perceptions of pain in the active and transition phases. Mean VAS scores of the massage and
hot-pack application groups were lower than those of the control group (p
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Goswami S, Jelly P, Sharma S, Negi R, Sharma R. The effect of heat therapy on pain intensity, duration of labor during first stage among primiparous women and Apgar scores: A systematic review and meta-analysis. Eur J Midwifery 2022; 6:66. [DOI: 10.18332/ejm/156487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 11/12/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022] Open
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Effects of Localized Heating on Pain, Skin Perfusion, and Wound Healing After Lumbar Decompression. J Neurosci Nurs 2020; 52:251-256. [DOI: 10.1097/jnn.0000000000000529] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Massage and heat application on labor pain and comfort: A quasi-randomized controlled experimental study. Explore (NY) 2020; 17:438-445. [PMID: 32828687 DOI: 10.1016/j.explore.2020.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/04/2020] [Accepted: 08/09/2020] [Indexed: 11/20/2022]
Abstract
AIM The aim of this study was to determine the effects of sacral massage and heat application on the perceptions of labor pain and comfort level in pregnant women. METHODS This was a quasi-randomized controlled experimental study. The data were collected under three groups in 2016: the heat application group (HAG), the massage group (MG), and the control group (CG). Each group included 30 primiparous pregnant women (range of age: 17-35) whose cervix was dilated to 4-5 cm. At 4-5 cm, 6-7 cm, and 8-9 cm cervical dilation, sacral massage was applied to MG, and sacral heat application was applied to HAG. Each group received standard midwifery care during labor. The data were collected using the Childbirth Comfort Questionnaire (CCQ) and the Numerical Rating Scale (NRS). The data were analyzed by using the Chi-square test, the Friedman test, Paired sample t-test, ANOVA, the Kruskal-Wallis test, and Wilcoxon signed-ranks test RESULTS: The mean pain score in HAG (4.56±0.67) during 4-5 cm of cervical dilation was significantly lower than those in MG (5.03±1.06) or CG (5.23±0.72) (p < 0.05). The mean pain scores in HAG (6.80±0.7) and MG (7.30±0.8) during 6-7 cm of cervical dilation were significantly lower than that in CG (7.70±0.5) (p < 0.001). Moreover, a statistically significant difference was found between the mean CCQ total scores (HAG: 31.06±3.46, CG: 27.66±3.85, p < 0.05), mean CCQ physical comfort scores (HAG: 13.16±1.89, CG: 11.03±1.80, p < 0.001), mean CCQ relief comfort level score (HAG: 11.23±1.43, CG: 10.00±2.01, p < 0.05) and mean CCQ transcendence comfort level scores (HAG: 19.83±2.37, CG: 17.66±2.15, p < 0.05) and both HAG and CG during 8-9 cm of cervical dilation. CONCLUSIONS Heat application and massage can be used as a safe and effective midwifery intervention to reduce the perception of pain in pregnant women and provide comfort during labor.
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Akin B, Saydam BK. The effect of labor dance on perceived labor pain, birth satisfaction, and neonatal outcomes. Explore (NY) 2020; 16:310-317. [PMID: 32527687 DOI: 10.1016/j.explore.2020.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 05/14/2020] [Accepted: 05/24/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This research was conducted to determine the effects of labor dance on perceived birth pain, birth satisfaction, and neonatal outcomes. DESIGN This is an experimental study. Data were collected under three groups during the active phase of labor: the dance practitioner midwife group (DPMG, comprising 40 pregnant women), the dance practitioner spouse/partner group (DPSG, comprising 40 pregnant women) and the control group (CG, comprising 80 pregnant women). SETTING This study was conducted between 1 April 2017 and 31 October 2017 in Turkey. PARTICIPANTS This study was administered on pregnant women volunteers with no risk during the active phase of labor. INTERVENTIONS During the active phase, pregnant women in DPMG danced with the midwife; pregnant women in DPSG, on the other hand, danced with their spouses/partners throughout the active phase. When vaginal dilatation reached 4 cm and 9 cm, labor pain was measured by employing the visual analog scale (VAS). In the postpartum phase, newborn babies' first, fifth, and tenth minute Apgar scores and oxygen saturation levels were measured and registered. In the first hour after delivery, the Mackey Birth Satisfaction Scale was administered. CG, on the other hand, received only the routine procedures offered in the hospital. FINDINGS The mean scores of VAS 1 and VAS 2 in DPSG and DPMG were lower than in CG. The fifth and tenth minute Apgar scores and the first, fifth, and tenth minute oxygen saturation levels of the newborns in the experimental groups, as well as the level of birth satisfaction, were significantly higher than in CG. KEY CONCLUSIONS The study showed a positive effect of labor dancing on the labor process.
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Affiliation(s)
- Bihter Akin
- Selcuk University, Faculty of Health Sciences, Midwifery Department, Konya, Turkey.
| | - Birsen Karaca Saydam
- Ege University, Faculty of Health Sciences, Midwifery Department, Izmir, Turkey.
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Kaur J, Sheoran P, Kaur S, Sarin J. Effectiveness of Warm Compression on Lumbo-Sacral Region in Terms of Labour Pain Intensity and Labour Outcomes among Nulliparous: an Interventional Study. J Caring Sci 2020; 9:9-12. [PMID: 32296653 PMCID: PMC7146727 DOI: 10.34172/jcs.2020.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/25/2019] [Indexed: 11/10/2022] Open
Abstract
Introduction: Childbirth is a distinctive and joyous moment in every mother’s life. Giving birth is one of the powerful and vital event. This study aimed to assess and evaluate the effectiveness of warm compression (moist heat) on lumbo-sacral region in terms of labor pain intensity and labor outcomes Methods: An experimental research design was carried out on 88 nulliparous mothers with normal singleton term pregnancy (44 participants in each group) who were admitted in the labor room. Mothers who had high-risk pregnancy were excluded. Warm compression was given to nulliparous mothers of the experimental group with hydrochollator pack at 70◦C temperature for 20 minutes for 3 times with one-hour interval on lumbo sacral region starting from 4-5 cm of cervical dilatation. Labor pain intensity score, fetal heart rate, frequency and duration of uterine contractions were assessed before and immediately of warm compression and again after 30 minutes only labor pain was assessed. Results: Study results revealed that immediately after first, second and third time of warm compression labor pain intensity score in experimental group was lower than control group respectively ( t= 3.20; P< 0.001; t =4.45; P< 0.001; t= 6.18; P< 0.001). But no significant difference found in fetal heart rate and labor outcomes in terms of duration of labor, type of delivery, baby born alive/ not and cried immediately after birth. Conclusion: Warm compression was useful method to decrease the labour pain among nulliparous mothers in the first stage of labour and mothers reported satisfaction with intervention.
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Affiliation(s)
- Jasvir Kaur
- Department Obstetrics and Gynaecological Nursing, Maharishi Markandeshwar College of Nursing, Maharishi Markandeshwar Deemed to be University, Mullana, India
| | - Poonam Sheoran
- Department Obstetrics and Gynaecological Nursing, Maharishi Markandeshwar College of Nursing, Maharishi Markandeshwar Deemed to be University, Mullana, India
| | - Simarjeet Kaur
- Department Obstetrics and Gynaecological Nursing, Maharishi Markandeshwar College of Nursing, Maharishi Markandeshwar Deemed to be University, Mullana, India
| | - Jyoti Sarin
- Nursing Faculty, Maharishi Markandeshwar Deemed to be University, Mullana, India
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Effects of electroacupuncture on reducing labor pain and complications in the labor analgesia process of combined spinal–epidural analgesia with patient-controlled epidural analgesia. Arch Gynecol Obstet 2018; 299:123-128. [DOI: 10.1007/s00404-018-4955-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 10/25/2018] [Indexed: 12/17/2022]
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Smith CA, Levett KM, Collins CT, Dahlen HG, Ee CC, Suganuma M. Massage, reflexology and other manual methods for pain management in labour. Cochrane Database Syst Rev 2018; 3:CD009290. [PMID: 29589380 PMCID: PMC6494169 DOI: 10.1002/14651858.cd009290.pub3] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Many women would like to avoid pharmacological or invasive methods of pain management in labour, and this may contribute towards the popularity of complementary methods of pain management. This review examined the evidence currently available on manual methods, including massage and reflexology, for pain management in labour. This review is an update of the review first published in 2012. OBJECTIVES To assess the effect, safety and acceptability of massage, reflexology and other manual methods to manage pain in labour. SEARCH METHODS For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register (30 June 2017), the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 6), MEDLINE (1966 to 30 June 2017, CINAHL (1980 to 30 June 2017), the Australian New Zealand Clinical Trials Registry (4 August 2017), Chinese Clinical Trial Registry (4 August 2017), ClinicalTrials.gov, (4 August 2017), the National Center for Complementary and Integrative Health (4 August 2017), the WHO International Clinical Trials Registry Platform (ICTRP) (4 August 2017) and reference lists of retrieved trials. SELECTION CRITERIA We included randomised controlled trials comparing manual methods with standard care, other non-pharmacological forms of pain management in labour, no treatment or placebo. We searched for trials of the following modalities: massage, warm packs, thermal manual methods, reflexology, chiropractic, osteopathy, musculo-skeletal manipulation, deep tissue massage, neuro-muscular therapy, shiatsu, tuina, trigger point therapy, myotherapy and zero balancing. We excluded trials for pain management relating to hypnosis, aromatherapy, acupuncture and acupressure; these are included in other Cochrane reviews. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality, extracted data and checked data for accuracy. We contacted trial authors for additional information. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS We included a total of 14 trials; 10 of these (1055 women) contributed data to meta-analysis. Four trials, involving 274 women, met our inclusion criteria but did not contribute data to the review. Over half the trials had a low risk of bias for random sequence generation and attrition bias. The majority of trials had a high risk of performance bias and detection bias, and an unclear risk of reporting bias. We found no trials examining the effectiveness of reflexology.MassageWe found low-quality evidence that massage provided a greater reduction in pain intensity (measured using self-reported pain scales) than usual care during the first stage of labour (standardised mean difference (SMD) -0.81, 95% confidence interval (CI) -1.06 to -0.56, six trials, 362 women). Two trials reported on pain intensity during the second and third stages of labour, and there was evidence of a reduction in pain scores in favour of massage (SMD -0.98, 95% CI -2.23 to 0.26, 124 women; and SMD -1.03, 95% CI -2.17 to 0.11, 122 women). There was very low-quality evidence showing no clear benefit of massage over usual care for the length of labour (in minutes) (mean difference (MD) 20.64, 95% CI -58.24 to 99.52, six trials, 514 women), and pharmacological pain relief (average risk ratio (RR) 0.81, 95% CI 0.37 to 1.74, four trials, 105 women). There was very low-quality evidence showing no clear benefit of massage for assisted vaginal birth (average RR 0.71, 95% CI 0.44 to 1.13, four trials, 368 women) and caesarean section (RR 0.75, 95% CI 0.51 to 1.09, six trials, 514 women). One trial reported less anxiety during the first stage of labour for women receiving massage (MD -16.27, 95% CI -27.03 to -5.51, 60 women). One trial found an increased sense of control from massage (MD 14.05, 95% CI 3.77 to 24.33, 124 women, low-quality evidence). Two trials examining satisfaction with the childbirth experience reported data on different scales; both found more satisfaction with massage, although the evidence was low quality in one study and very low in the other.Warm packsWe found very low-quality evidence for reduced pain (Visual Analogue Scale/VAS) in the first stage of labour (SMD -0.59, 95% CI -1.18 to -0.00, three trials, 191 women), and the second stage of labour (SMD -1.49, 95% CI -2.85 to -0.13, two trials, 128 women). Very low-quality evidence showed reduced length of labour (minutes) in the warm-pack group (MD -66.15, 95% CI -91.83 to -40.47; two trials; 128 women).Thermal manual methodsOne trial evaluated thermal manual methods versus usual care and found very low-quality evidence of reduced pain intensity during the first phase of labour for women receiving thermal methods (MD -1.44, 95% CI -2.24 to -0.65, one trial, 96 women). There was a reduction in the length of labour (minutes) (MD -78.24, 95% CI -118.75 to -37.73, one trial, 96 women, very low-quality evidence). There was no clear difference for assisted vaginal birth (very low-quality evidence). Results were similar for cold packs versus usual care, and intermittent hot and cold packs versus usual care, for pain intensity, length of labour and assisted vaginal birth.Music One trial that compared manual methods with music found very low-quality evidence of reduced pain intensity during labour in the massage group (RR 0.40, 95% CI 0.18 to 0.89, 101 women). There was no evidence of benefit for reduced use of pharmacological pain relief (RR 0.41, 95% CI 0.16 to 1.08, very low-quality evidence).Of the seven outcomes we assessed using GRADE, only pain intensity was reported in all comparisons. Satisfaction with the childbirth experience, sense of control, and caesarean section were rarely reported in any of the comparisons. AUTHORS' CONCLUSIONS Massage, warm pack and thermal manual methods may have a role in reducing pain, reducing length of labour and improving women's sense of control and emotional experience of labour, although the quality of evidence varies from low to very low and few trials reported on the key GRADE outcomes. Few trials reported on safety as an outcome. There is a need for further research to address these outcomes and to examine the effectiveness and efficacy of these manual methods for pain management.
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Affiliation(s)
- Caroline A Smith
- Western Sydney UniversityNational Institute of Complementary Medicine (NICM)Locked Bag 1797PenrithNew South WalesAustralia2751
| | - Kate M Levett
- The University of Notre DameSchool of MedicineSydneyAustralia
| | - Carmel T Collins
- South Australian Health and Medical Research InstituteHealthy Mothers, Babies and Children72 King William RoadNorth AdelaideSouth AustraliaAustralia5006
| | - Hannah G Dahlen
- Western Sydney UniversitySchool of Nursing and MidwiferyLocked Bag 1797PenrithNSWAustralia2751
| | - Carolyn C Ee
- Western Sydney UniversityNational Institute of Complementary Medicine (NICM)Locked Bag 1797PenrithNew South WalesAustralia2751
| | - Machiko Suganuma
- South Australian Health and Medical Research InstituteHealthy Mothers, Babies and Children72 King William RoadNorth AdelaideSouth AustraliaAustralia5006
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Akbarzadeh M, Nematollahi A, Farahmand M, Amooee S. The Effect of Two-Staged Warm Compress on the Pain Duration of First and Second Labor Stages and Apgar Score in Prim Gravida Women: a Randomized Clinical Trial. J Caring Sci 2018; 7:21-26. [PMID: 29637053 PMCID: PMC5889794 DOI: 10.15171/jcs.2018.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 12/10/2017] [Indexed: 11/16/2022] Open
Abstract
Introduction: The aim of this study was to assess the
effect of two-stage warm compress technique on the pain duration of the first
and second labor stages and neonatal outcomes.
Methods: The clinical trial was done
on 150 women (75 subjects in each groups) in Shiraz-affiliated hospitals in
2012 A
two-staged warm compress was done for 15-20 minutes in the first and second
labor phase (cervical dilatation of 7 and 10 cm with zero status) while the
control group received hospital routine care. The duration of labor and Apgar
score were evaluated.
Results: According to t-test,
the average of labor duration was lower in the intervention group compared to
the control group at the second stage. However, there was no significant
difference for labor duration at the first stage and the first and fifth minute
Apgar score.
Conclusion: According to the result, this intervention seems
a good method for decreasing labor duration at the second stage of parturition.
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Affiliation(s)
- Marzieh Akbarzadeh
- Department of Midwifery, Maternal-fetal Medicine Research Center, Faculty of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azar Nematollahi
- Department of Midwifery, Community Based Psychiatric Care Research Centre, Fatemeh Faculty of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahnaz Farahmand
- Department of Obstetrics and Gynecology, Student Research Committee, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sedigheh Amooee
- Department of Obstetrics and Gynecology, Student Research Committee, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Aasheim V, Nilsen ABV, Reinar LM, Lukasse M. Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database Syst Rev 2017; 6:CD006672. [PMID: 28608597 PMCID: PMC6481402 DOI: 10.1002/14651858.cd006672.pub3] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Most vaginal births are associated with trauma to the genital tract. The morbidity associated with perineal trauma can be significant, especially when it comes to third- and fourth-degree tears. Different interventions including perineal massage, warm or cold compresses, and perineal management techniques have been used to prevent trauma. This is an update of a Cochrane review that was first published in 2011. OBJECTIVES To assess the effect of perineal techniques during the second stage of labour on the incidence and morbidity associated with perineal trauma. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (26 September 2016) and reference lists of retrieved studies. SELECTION CRITERIA Published and unpublished randomised and quasi-randomised controlled trials evaluating perineal techniques during the second stage of labour. Cross-over trials were not eligible for inclusion. DATA COLLECTION AND ANALYSIS Three review authors independently assessed trials for inclusion, extracted data and evaluated methodological quality. We checked data for accuracy. MAIN RESULTS Twenty-two trials were eligible for inclusion (with 20 trials involving 15,181 women providing data). Overall, trials were at moderate to high risk of bias; none had adequate blinding, and most were unclear for both allocation concealment and incomplete outcome data. Interventions compared included the use of perineal massage, warm and cold compresses, and other perineal management techniques.Most studies did not report data on our secondary outcomes. We downgraded evidence for risk of bias, inconsistency, and imprecision for all comparisons. Hands off (or poised) compared to hands onHands on or hands off the perineum made no clear difference in incidence of intact perineum (average risk ratio (RR) 1.03, 95% confidence interval (CI) 0.95 to 1.12, two studies, Tau² 0.00, I² 37%, 6547 women; moderate-quality evidence), first-degree perineal tears (average RR 1.32, 95% CI 0.99 to 1.77, two studies, 700 women; low-quality evidence), second-degree tears (average RR 0.77, 95% CI 0.47 to 1.28, two studies, 700 women; low-quality evidence), or third- or fourth-degree tears (average RR 0.68, 95% CI 0.21 to 2.26, five studies, Tau² 0.92, I² 72%, 7317 women; very low-quality evidence). Substantial heterogeneity for third- or fourth-degree tears means these data should be interpreted with caution. Episiotomy was more frequent in the hands-on group (average RR 0.58, 95% CI 0.43 to 0.79, Tau² 0.07, I² 74%, four studies, 7247 women; low-quality evidence), but there was considerable heterogeneity between the four included studies.There were no data for perineal trauma requiring suturing. Warm compresses versus control (hands off or no warm compress)A warm compress did not have any clear effect on the incidence of intact perineum (average RR 1.02, 95% CI 0.85 to 1.21; 1799 women; four studies; moderate-quality evidence), perineal trauma requiring suturing (average RR 1.14, 95% CI 0.79 to 1.66; 76 women; one study; very low-quality evidence), second-degree tears (average RR 0.95, 95% CI 0.58 to 1.56; 274 women; two studies; very low-quality evidence), or episiotomy (average RR 0.86, 95% CI 0.60 to 1.23; 1799 women; four studies; low-quality evidence). It is uncertain whether warm compress increases or reduces the incidence of first-degree tears (average RR 1.19, 95% CI 0.38 to 3.79; 274 women; two studies; I² 88%; very low-quality evidence).Fewer third- or fourth-degree perineal tears were reported in the warm-compress group (average RR 0.46, 95% CI 0.27 to 0.79; 1799 women; four studies; moderate-quality evidence). Massage versus control (hands off or routine care)The incidence of intact perineum was increased in the perineal-massage group (average RR 1.74, 95% CI 1.11 to 2.73, six studies, 2618 women; I² 83% low-quality evidence) but there was substantial heterogeneity between studies). This group experienced fewer third- or fourth-degree tears (average RR 0.49, 95% CI 0.25 to 0.94, five studies, 2477 women; moderate-quality evidence).There were no clear differences between groups for perineal trauma requiring suturing (average RR 1.10, 95% CI 0.75 to 1.61, one study, 76 women; very low-quality evidence), first-degree tears (average RR 1.55, 95% CI 0.79 to 3.05, five studies, Tau² 0.47, I² 85%, 537 women; very low-quality evidence), or second-degree tears (average RR 1.08, 95% CI 0.55 to 2.12, five studies, Tau² 0.32, I² 62%, 537 women; very low-quality evidence). Perineal massage may reduce episiotomy although there was considerable uncertainty around the effect estimate (average RR 0.55, 95% CI 0.29 to 1.03, seven studies, Tau² 0.43, I² 92%, 2684 women; very low-quality evidence). Heterogeneity was high for first-degree tear, second-degree tear and for episiotomy - these data should be interpreted with caution. Ritgen's manoeuvre versus standard careOne study (66 women) found that women receiving Ritgen's manoeuvre were less likely to have a first-degree tear (RR 0.32, 95% CI 0.14 to 0.69; very low-quality evidence), more likely to have a second-degree tear (RR 3.25, 95% CI 1.73 to 6.09; very low-quality evidence), and neither more nor less likely to have an intact perineum (RR 0.17, 95% CI 0.02 to 1.31; very low-quality evidence). One larger study reported that Ritgen's manoeuvre did not have an effect on incidence of third- or fourth-degree tears (RR 1.24, 95% CI 0.78 to 1.96,1423 women; low-quality evidence). Episiotomy was not clearly different between groups (RR 0.81, 95% CI 0.63 to 1.03, two studies, 1489 women; low-quality evidence). Other comparisonsThe delivery of posterior versus anterior shoulder first, use of a perineal protection device, different oils/wax, and cold compresses did not show any effects on perineal outcomes. Only one study contributed to each of these comparisons, so data were insufficient to draw conclusions. AUTHORS' CONCLUSIONS Moderate-quality evidence suggests that warm compresses, and massage, may reduce third- and fourth-degree tears but the impact of these techniques on other outcomes was unclear or inconsistent. Poor-quality evidence suggests hands-off techniques may reduce episiotomy, but this technique had no clear impact on other outcomes. There were insufficient data to show whether other perineal techniques result in improved outcomes.Further research could be performed evaluating perineal techniques, warm compresses and massage, and how different types of oil used during massage affect women and their babies. It is important for any future research to collect information on women's views.
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Affiliation(s)
- Vigdis Aasheim
- Western Norway University of Applied SciencesFaculty of Health and Social SciencesBergenNorway
| | - Anne Britt Vika Nilsen
- Western Norway University of Applied SciencesFaculty of Health and Social SciencesBergenNorway
| | - Liv Merete Reinar
- Norwegian Institute of Public HealthDivision for Health ServicesPO Box 4404NydalenOsloNorway0403
| | - Mirjam Lukasse
- University College of Southeast NorwayFaculty of Health and Social SciencesOsloNorway
- Oslo and Akershus University CollegeFaculty of Health SciencesPB4St.Olavs plassOsloNorwayN‐0130
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Feng X, Ye T, Wang Z, Chen X, Cong W, Chen Y, Chen P, Chen C, Shi B, Xie W. Transcutaneous acupoint electrical stimulation pain management after surgical abortion: A cohort study. Int J Surg 2016; 30:104-8. [PMID: 27142864 DOI: 10.1016/j.ijsu.2016.04.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 04/19/2016] [Accepted: 04/26/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Transcutaneous acupoint electrical stimulation (TEAS) is a standard therapy for painful conditions. This study evaluated pain-relieving effects of treatment with TEAS before and after surgical abortion. METHODS In this cohort study 140 nulliparae requesting pregnancy termination with intravenous anesthesia from August to December 2013 at the outpatient clinic of Wenzhou Medical University First Affiliated Hospital were recruited and divided into three cohorts who received TEAS pre-, post-, and both pre- and post-operation, alongside a control group. The cohorts underwent TEAS treatment for 30 min before and/or after the procedure while the control group received no TEAS treatment. Pain levels were evaluated upon recovery at 10, 30, and 45 min, respectively, after abortion. RESULTS Mean Visual Analog Scale (VAS) scores in pre-operation cohorts, but not the post-operation cohort, were significantly lower than those obtained for the control group at 10 min (p < 0.01). VAS scores at 30 min and 45 min postoperatively were similar in each cohort but lower than control values (p < 0.001). More cohort patients reported mild or no pain than control patients (p < 0.05); the pre-operation cohorts had more women with no pain compared with the post-operation group (p < 0.05). There were no differences among groups in medical treatment required after 45 min. There were fewer complications of nausea and vomiting in the cohorts compared with the control group (p < 0.05). CONCLUSIONS Performing TEAS before and after surgical abortion provides postoperative pain relief. However, receiving TEAS before surgery allowed more women to experience mild or no pain. IMPLICATIONS Transcutaneous acupoint electrical stimulation shows potential as an adjunct to conventional pain treatment following surgical abortion in nulliparae.
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Affiliation(s)
- Xiaozhen Feng
- Department of Acupuncture & Physiotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Tianshen Ye
- Department of Acupuncture & Physiotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zedong Wang
- Department of Acupuncture & Physiotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiufang Chen
- Department of Geriatric Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenjie Cong
- Department of Acupuncture & Physiotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yong Chen
- Department of Acupuncture & Physiotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Pinjie Chen
- Department of Acupuncture & Physiotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chong Chen
- Department of Acupuncture & Physiotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Beibei Shi
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Wenxia Xie
- Department of Acupuncture & Physiotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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Ye L, Mingjun X, Xiangming C, Junqin H, Dandan G, Guosheng Z, Guogang Z, Shuo Z, Kai K, Chunlei Z, Yinan W, Shan L, Qinglin Z, Li X, Ming Z, Bin H, Yumiao J, Ning Z. Effect of direct current pulse stimulating acupoints of JiaJi (T10-L3) and Ciliao (BL 32) with Han's Acupoint Nerve Stimulator on labour pain in women: a randomized controlled clinical study. J TRADIT CHIN MED 2015; 35:620-5. [DOI: 10.1016/s0254-6272(15)30149-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Dhippayom T, Kongkaew C, Chaiyakunapruk N, Dilokthornsakul P, Sruamsiri R, Saokaew S, Chuthaputti A. Clinical effects of thai herbal compress: a systematic review and meta-analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2015; 2015:942378. [PMID: 25861373 PMCID: PMC4377500 DOI: 10.1155/2015/942378] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 02/03/2015] [Accepted: 02/04/2015] [Indexed: 11/18/2022]
Abstract
Objective. To determine the clinical effects of Thai herbal compress. Methods. International and Thai databases were searched from inception through September 2014. Comparative clinical studies investigating herbal compress for any indications were included. Outcomes of interest included level of pain, difficulties in performing activities, and time from delivery to milk secretion. Mean changes of the outcomes from baseline were compared between herbal compress and comparators by calculating mean difference. Results. A total of 13 studies which involved 778 patients were selected from 369 articles identified. The overall effects of Thai herbal compress on reducing osteoarthritis (OA) and muscle pain were not different from those of nonsteroidal anti-inflammatory drugs, knee exercise, and hot compress. However, the reduction of OA pain in the herbal compress group tended to be higher than that of any comparators (weighted mean difference 0.419; 95% CI -0.004, 0.842) with moderate heterogeneity (I (2) = 58.3%, P = 0.048). When compared with usual care, herbal compress provided significantly less time from delivery to milk secretion in postpartum mothers (mean difference -394.425 minutes; 95% CI -620.084, -168.766). Conclusion. Thai herbal compress may be considered as an alternative for osteoarthritis and muscle pain and could also be used as a treatment of choice to induce lactation.
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Affiliation(s)
- Teerapon Dhippayom
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok 47500, Thailand
| | - Chuenjid Kongkaew
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok 47500, Thailand
- Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok 65000, Thailand
- Center of Excellence for Environmental Health and Toxicology, Naresuan University, Phitsanulok, Thailand
| | - Nathorn Chaiyakunapruk
- Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok 65000, Thailand
- School of Pharmacy, Monash University Malaysia, Kuala Lumpur, Malaysia
- School of Population Health, University of Queensland, Brisbane, QLD 4006, Australia
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Piyameth Dilokthornsakul
- Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok 65000, Thailand
| | - Rosarin Sruamsiri
- Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok 65000, Thailand
| | - Surasak Saokaew
- Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao 56000, Thailand
| | - Anchalee Chuthaputti
- Department for Development of Thai Traditional and Alternative Medicine, Ministry of Public Health, Nonthaburi 11000, Thailand
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