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Sun R, Huang J, Zhu X, Hou R, Zang Y, Li Y, Pan J, Lu H. Effects of Perineal Warm Compresses during the Second Stage of Labor on Reducing Perineal Trauma and Relieving Postpartum Perineal Pain in Primiparous Women: A Systematic Review and Meta-Analyses. Healthcare (Basel) 2024; 12:702. [PMID: 38610125 PMCID: PMC11011582 DOI: 10.3390/healthcare12070702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/08/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
Non-pharmaceutical midwifery techniques, including perineal warm compresses, to improve maternal outcomes remain controversial. The aims of this study are to assess the effects of perineal warm compresses on reducing perineal trauma and postpartum perineal pain relief. This systematic review included randomized controlled trials (RCTs). We searched seven bibliographic databases, three RCT register websites, and two dissertation databases for publications from inception to 15 March 2023. Chinese and English publications were included. Two independent reviewers conducted the risk of bias assessment, data extraction, and the evaluation of the certainty of the evidence utilizing the Cochrane risk of bias 2.0 assessment criteria, the Review Manager 5.4, and the online GRADEpro tool, respectively. Seven RCTs involving 1362 primiparous women were included. The combined results demonstrated a statistically significant reduction in the second-, third- and/or fourth- degree perineal lacerations, the incidence of episiotomy, and the relief of the short-term perineal pain postpartum (within two days). There was a potential favorable effect on improving the integrity of the perineum. However, the results did not show a statistically significant supportive effect on reducing first-degree perineal lacerations and the rate of perineal lacerations requiring sutures. In summary, perineal warm compresses effectively reduced the second-, third-/or fourth-degree perineal trauma and decreased the short-term perineal pain after birth.
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Affiliation(s)
- Ruiyang Sun
- School of Nursing, Beijing University of Chinese Medicine, Beijing 102488, China;
| | - Jing Huang
- Division of Care for Long Term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London SE1 8WA, UK;
| | - Xiu Zhu
- School of Nursing, Peking University, Beijing 100191, China; (X.Z.); (R.H.); (J.P.)
| | - Rui Hou
- School of Nursing, Peking University, Beijing 100191, China; (X.Z.); (R.H.); (J.P.)
| | - Yu Zang
- School of Nursing, Hebei Medical University, Shijiazhuang 050017, China;
| | - Yuxuan Li
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China;
| | - Jingyu Pan
- School of Nursing, Peking University, Beijing 100191, China; (X.Z.); (R.H.); (J.P.)
| | - Hong Lu
- School of Nursing, Peking University, Beijing 100191, China; (X.Z.); (R.H.); (J.P.)
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3
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Nori W, Kassim MAK, Helmi ZR, Pantazi AC, Brezeanu D, Brezeanu AM, Penciu RC, Serbanescu L. Non-Pharmacological Pain Management in Labor: A Systematic Review. J Clin Med 2023; 12:7203. [PMID: 38068274 PMCID: PMC10707619 DOI: 10.3390/jcm12237203] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 04/22/2024] Open
Abstract
Childbirth is a remarkable, life-changing process and is frequently regarded as an excruciating, physically and emotionally demanding experience that women endure. Labor pain management poses a significant challenge for obstetricians and expectant mothers. Although pharmacological pain management is the gold standard, it still imposes risks on the mother and baby. Recently, non-pharmacological pain management (NPPM) has emerged as a safe, effective option. Six databases were searched for articles published up to 2023 using specific related keywords and defined inclusion and exclusion criteria. The extraction and gathering of data was made so as to be categorized into physical, psychological, and complementary NPPM techniques. In light of the enormous development and diversity of NPPM techniques, the present review aims to examine contemporary NPPM knowledge and application, discussing efficacy, advantages, limitations, and potential adverse effects, with a specific focus on women's individual requirements, to strengthen obstetricians' knowledge in guiding decision-making for women in childbirth.
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Affiliation(s)
- Wassan Nori
- College of Medicine, Mustansiriyah University, Baghdad 10052, Iraq;
| | - Mustafa Ali Kassim Kassim
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (D.B.); (A.M.B.); (R.C.P.); (L.S.)
| | - Zeena Raad Helmi
- College of Medicine, Mustansiriyah University, Baghdad 10052, Iraq;
| | - Alexandru Cosmin Pantazi
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (D.B.); (A.M.B.); (R.C.P.); (L.S.)
| | - Dragos Brezeanu
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (D.B.); (A.M.B.); (R.C.P.); (L.S.)
- Obstetrics and Gynecology Department, Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania
| | - Ana Maria Brezeanu
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (D.B.); (A.M.B.); (R.C.P.); (L.S.)
- Obstetrics and Gynecology Department, Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania
| | - Roxana Cleopatra Penciu
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (D.B.); (A.M.B.); (R.C.P.); (L.S.)
- Obstetrics and Gynecology Department, Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania
| | - Lucian Serbanescu
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (D.B.); (A.M.B.); (R.C.P.); (L.S.)
- Obstetrics and Gynecology Department, Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania
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5
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Zhu Y, Wang F, Zhou J, Gu S, Gong L, Lin Y, Hu X, Wang W, Zhang A, Ma D, Hu C, Wu Y, Guo L, Chen L, Cen L, He Y, Cai Y, Wang E, Chen H, Jin J, Huang J, Jin M, Sun X, Ye X, Jiang L, Zhang Y, Zhang J, Lin J, Zhang C, Shen G, Jiang W, Zhong L, Zhou Y, Wu R, Lu S, Feng L, Guo H, Lin S, Chen Q, Kong J, Yang X, Tang M, Liu C, Wang F, Hu XYM, Lee HW, Xu X, Zhang R, Robinson N, Lee MS, Han J, Qu F. Effect of Acupoint Hot Compress on Postpartum Urinary Retention After Vaginal Delivery: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2213261. [PMID: 35604687 PMCID: PMC9127553 DOI: 10.1001/jamanetworkopen.2022.13261] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPORTANCE Acupoint hot compress during the early postpartum period may benefit patients after a vaginal delivery, but the evidence of this effect is limited. OBJECTIVE To assess whether acupoint hot compress involving the abdominal, lumbosacral, and plantar regions could reduce the incidence of postpartum urinary retention, relieve postpartum uterine contraction pain, prevent emotional disorders, and promote lactation. DESIGN, SETTING, AND PARTICIPANTS This multicenter randomized clinical trial was conducted at 12 hospitals in China. Pregnant patients were screened for eligibility (n = 13 949) and enrolled after vaginal delivery (n = 1200) between January 17 and August 15, 2021; data collection was completed on August 18, 2021. After vaginal delivery, these participants were randomized 1:1 to either the intervention group or control group. Statistical analysis was based on per-protocol population. INTERVENTIONS Participants in the control group received routine postpartum care. Participants in the intervention group received routine postpartum care plus 3 sessions of a 4-hour acupoint hot compress involving the abdominal, lumbosacral, and plantar regions within 30 minutes, 24 hours, and 48 hours after delivery. MAIN OUTCOMES AND MEASURES The primary outcome was the incidence of postpartum urinary retention, defined as the first urination occurring more than 6.5 hours after delivery and/or use of an indwelling catheter within 72 hours after delivery. The secondary outcomes were postpartum uterine contraction pain intensity (assessed with the visual analog scale [VAS]), depressive symptoms (assessed with the Edinburgh Postnatal Depression Scale), and lactation conditions (including lactation initiation time, breastfeeding milk volume, feeding mood and times, and newborn weight). RESULTS Of the 1200 participants randomized, 1085 completed the study (537 in the intervention group and 548 in the control group, with a median [IQR] age of 26.0 [24.0-29.0] years). Participants in the intervention group compared with the control group had significantly decreased incidence of postpartum urinary retention (relative risk [RR], 0.58; 95% CI, 0.35-0.98; P = .03); improved postpartum uterine contraction pain when measured at 6.5 hours (median [IQR] VAS score, 1 [1-2] vs 2 [1-2]; P < .001), 28.5 hours (median [IQR] VAS score, 1 [0-1] vs 1 [1-2]; P < .001), 52.5 hours (median [IQR] VAS score, 1 [0-1] vs 1 [0-1]; P < .001), and 76.5 hours (median [IQR] VAS score, 0 [0-1] vs 0 [0-1]; P = .01) after delivery; reduced depressive symptoms (RR, 0.73; 95% CI, 0.54-0.98; P = .01); and increased breastfeeding milk volume measured at 28.5, 52.5, and 76.5 hours after delivery. No adverse events occurred in either of the 2 groups. CONCLUSIONS AND RELEVANCE Results of this trial showed that acupoint hot compress after vaginal delivery decreased postpartum urinary retention, uterine contraction pain, and depressive symptoms and increased breastfeeding milk volume. Acupoint hot compress may be considered as an adjunctive intervention in postnatal care that meets patient self-care needs. TRIAL REGISTRATION Chinese Clinical Trial Registry Identifier: ChiCTR2000038417.
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Affiliation(s)
- Yuhang Zhu
- Department of Chinese Integrative Medicine, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fangfang Wang
- Department of Chinese Integrative Medicine, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jue Zhou
- School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
| | - Shuiqin Gu
- Department of Obstetrics, Jiaxing Maternity and Child Health Care Hospital, Jiaxing, China
| | - Lianqing Gong
- Department of Obstetrics, Yiwu Maternity and Child Health Care Hospital, Yiwu, China
| | - Yaoyao Lin
- Department of Epidemiology and Biostatistics at School of Public Health and the Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoli Hu
- Department of Chinese Integrative Medicine, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wei Wang
- Department of Obstetrics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Aihua Zhang
- Department of Obstetrics, Xianju People’s Hospital, Xianju, China
| | - Dongmei Ma
- Department of Chinese Integrative Medicine, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chunxiao Hu
- Department of Chinese Integrative Medicine, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yan Wu
- Department of Chinese Integrative Medicine, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lanzhong Guo
- Department of Obstetrics, The Women and Children Hospital of Dongyang, Dongyang, China
| | - Limin Chen
- Department of Obstetrics, Shaoxing Maternity and Child Health Care Hospital, Shaoxing, China
| | - Leiyin Cen
- Department of Obstetrics, Cixi Maternity and Child Health Care Hospital, Cixi, China
| | - Yan He
- Department of Obstetrics, Zhoushan Women and Children Hospital, Zhoushan, China
| | - Yuqing Cai
- Department of Obstetrics, Ruian People’s Hospital, Ruian, China
| | - Enli Wang
- Department of Obstetrics, Wenling Maternity and Child Health Care Hospital, Wenling, China
| | - Honglou Chen
- Department of Obstetrics, Zhejiang Xiaoshan Hospital, Hangzhou, China
| | - Jing Jin
- Department of Obstetrics, Jiaxing Maternity and Child Health Care Hospital, Jiaxing, China
| | - Jinhe Huang
- Department of Obstetrics, Yiwu Maternity and Child Health Care Hospital, Yiwu, China
| | - Meiyuan Jin
- Department of Obstetrics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Xiujuan Sun
- Department of Obstetrics, Shaoxing Maternity and Child Health Care Hospital, Shaoxing, China
| | - Xiaojiao Ye
- Department of Obstetrics, The Women and Children Hospital of Dongyang, Dongyang, China
| | - Linping Jiang
- Department of Obstetrics, Cixi Maternity and Child Health Care Hospital, Cixi, China
| | - Ying Zhang
- Department of Obstetrics, Zhoushan Women and Children Hospital, Zhoushan, China
| | - Jian Zhang
- Department of Obstetrics, Ruian People’s Hospital, Ruian, China
| | - Junfei Lin
- Department of Obstetrics, Wenling Maternity and Child Health Care Hospital, Wenling, China
| | - Chunping Zhang
- Department of Obstetrics, Xianju People’s Hospital, Xianju, China
| | - Guofang Shen
- Department of Obstetrics, Zhejiang Xiaoshan Hospital, Hangzhou, China
| | - Wei Jiang
- Department of Obstetrics, Jiaxing Maternity and Child Health Care Hospital, Jiaxing, China
| | - Liuyan Zhong
- Department of Obstetrics, Yiwu Maternity and Child Health Care Hospital, Yiwu, China
| | - Yuefang Zhou
- Department of Obstetrics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Ruoya Wu
- Department of Obstetrics, Shaoxing Maternity and Child Health Care Hospital, Shaoxing, China
| | - Shiqing Lu
- Department of Obstetrics, The Women and Children Hospital of Dongyang, Dongyang, China
| | - Linlin Feng
- Department of Obstetrics, Cixi Maternity and Child Health Care Hospital, Cixi, China
| | - Hong Guo
- Department of Obstetrics, Zhoushan Women and Children Hospital, Zhoushan, China
| | - Shanhu Lin
- Department of Obstetrics, Ruian People’s Hospital, Ruian, China
| | - Qiaosu Chen
- Department of Obstetrics, Wenling Maternity and Child Health Care Hospital, Wenling, China
| | - Jinfang Kong
- Department of Obstetrics, Zhejiang Xiaoshan Hospital, Hangzhou, China
| | - Xuan Yang
- Department of Chinese Integrative Medicine, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Mengling Tang
- Department of Epidemiology and Biostatistics at School of Public Health and the Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chang Liu
- Department of Obstetrics, The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Fang Wang
- Department of Chinese Integrative Medicine, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiao-Yang Mio Hu
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Hye Won Lee
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Xinfen Xu
- Department of Chinese Integrative Medicine, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Rong Zhang
- Neuroscience Research Institute, Peking University, Beijing, China
| | - Nicola Robinson
- School of Health and Social Care, London South Bank University, London, United Kingdom
| | - Myeong Soo Lee
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Jisheng Han
- Neuroscience Research Institute, Peking University, Beijing, China
| | - Fan Qu
- Department of Chinese Integrative Medicine, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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9
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Magoga G, Saccone G, Al-Kouatly HB, Dahlen G H, Thornton C, Akbarzadeh M, Ozcan T, Berghella V. Warm perineal compresses during the second stage of labor for reducing perineal trauma: A meta-analysis. Eur J Obstet Gynecol Reprod Biol 2019; 240:93-98. [PMID: 31238205 DOI: 10.1016/j.ejogrb.2019.06.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/30/2019] [Accepted: 06/11/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Perineal trauma may have a negative impact on women's lives as it has been associated with perineal pain, urinary incontinence and sexual dysfunction. The aim of this systematic review and meta-analysis of randomized controlled trials was to evaluate the effectiveness of warm compresses during the second stage of labor in reducing perineal trauma. METHODS Electronic databases were searched from inception of each database to May 2019. Inclusion criteria were randomized trials comparing warm compresses (i.e. intervention group) with no warm compresses (i.e. control group) during the second stage of labor. Types of participants included pregnant women planning to have a spontaneous vaginal birth at term with a singleton in a cephalic presentation. The primary outcome was the incidence of intact perineum. Meta-analysis was performed using the Cochrane Collaboration methodology with results being reported as relative risk (RR) with 95% confidence interval (CI). RESULTS Seven trials, including 2103 participants, were included in this meta-analysis. Women assigned to the intervention group received warm compresses made from clean washcloths or perineal pads immersed in warm tap water. These were held against the woman's perineum during and in between pushes in second stage. Warm compresses usually started when the baby's head began to distend the perineum or when there was active fetal descent in the second stage of labor. We found a higher rate of intact perineum in the intervention group compared to the control group (22.4% vs 15.4%; RR 1.46, 95% CI 1.22 to 1.74); a lower rate of third degree tears (1.9% vs 5.0%; RR 0.38, 95% CI 0.22 to 0.64), fourth degree tears (0.0% vs 0.9%; RR 0.11, 95% CI 0.01 to 0.86) third and fourth degree tears combined (1.9% vs 5.8%; RR 0.34, 95% CI 0.20 to 0.56) and episiotomy (10.4% vs 17.1%; RR 0.61, 95% CI 0.51 to 0.74). CONCLUSION Warm compresses applied during the second stage of labor increase the incidence of intact perineum and lower the risk of episiotomy and severe perineal trauma.
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Affiliation(s)
- Giulia Magoga
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.
| | - Huda B Al-Kouatly
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Hannah Dahlen G
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Charlene Thornton
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Marzieh Akbarzadeh
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Iran
| | - Tulin Ozcan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, USA
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
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