Incontinencia fecal posparto. Revisión de conjunto

Effects of transcutaneous electric nerve stimulation on pain after episiotomy. A systematic review and meta-analysis

Background

Episiotomy is a surgical intervention performed during the second stage of labor to facilitate the baby's exit through the birth canal. There are different reasons that lead to an episiotomy; however, it is recommended to be performed occasionally and not systematically, since it may produce negative effects such as pain. Different therapies have been described to reduce this pain, including transcutaneous electrical nerve stimulation (TENS).

Objective

To conduct a systematic review and meta-analysis about the effects of Transcutaneous Electric Nerve Stimulation (TENS) on pain after episiotomy.

Methods

The databases PubMed, Cochrane, Scopus, Cinhal, PEDro and Web of Science were consulted using the terms "Episiotomy" and "Transcutaneous Electric Nerve Stimulation". The methodological quality was analyzed with the PEDro scale. A random-effects model was used to carry out the meta-analysis.

Findings

88 studies were obtained and after applying the selection criteria, 6 were included in the systematic review and 5 in the meta-analysis. There were significant positive effects in decreasing the pain for TENS in comparison with pre-intervention (SMD = 1.19 [95 % CI - 0.33 to 2.05]; p < 0.01; I2 = 96 %), control group (SMD = -1.07 [95 % CI - -1.53 to -0.6]; p < 0.01; I2 = 82 %) and placebo group (SMD = -1.33 [95 % CI - -2.32 to -0.34]; p < 0.01; I2 = 86 %).

Conclusion

TENS appears to have a positive effect in reducing pain after 1 h of an episiotomy. The location of the electrodes does not seem to be relevant in the effects.

[Medical recommendations from primary care on physical exercise in the postpartum]

There is evidence that demonstrates the benefits of practicing physical activity/exercise for the mother after childbirth. However, this postpartum period (PP) is often a missed opportunity in a lifetime for women to start or resume physical exercise and get the great benefits that it can bring them. The objective of this article was to analyze the benefits of physical exercise during PP; the prescription of physical exercise; recommendations on when to resume your practice; barriers and facilitators; physical exercise during breastfeeding; as well as its role in the most frequent illnesses and discomforts in this period, always keeping in mind that the work of the primary care doctor is essential to motivate and encourage women to perform physical exercise in the PP.