Intervention Review

Analgesia for relief of pain due to uterine cramping/involution after birth

  1. Andrea R Deussen1,*,
  2. Pat Ashwood1,
  3. Ruth Martis2

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 11 MAY 2011

Assessed as up-to-date: 6 APR 2011

DOI: 10.1002/14651858.CD004908.pub2

How to Cite

Deussen AR, Ashwood P, Martis R. Analgesia for relief of pain due to uterine cramping/involution after birth. Cochrane Database of Systematic Reviews 2011, Issue 5. Art. No.: CD004908. DOI: 10.1002/14651858.CD004908.pub2.

Author Information

  1. 1

    The University of Adelaide, Discipline of Obstetrics and Gynaecology, North Adelaide, South Australia, Australia

  2. 2

    Christchurch Polytechnic Institute of Technology (CPIT), Faculty of Applied Sciences and Allied Health, School of Midwifery, Christchurch, New Zealand

*Andrea R Deussen, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Women's and Children's Hospital, Level 1 QVB, 72 King William Street, North Adelaide, South Australia, 5006, Australia. andrea.deussen@adelaide.edu.au.

Publication History

  1. Publication Status: New
  2. Published Online: 11 MAY 2011

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Background

Women may experience differing types of pain and discomfort following birth, including cramping after birth pains associated with uterine involution.

Objectives

To assess the effectiveness and safety of analgesia for relief of after birth pains following vaginal birth.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 December 2010) and the reference lists of trials and review articles.

Selection criteria

All identified published and unpublished randomised controlled trials comparing two different types of analgesia or analgesia with placebo or analgesia with no treatment, for the relief of after birth pains following vaginal birth. Types of analgesia included pharmacological and non-pharmacological.

Data collection and analysis

Two review authors assessed trial quality and extracted data independently.

Main results

We have included 18 studies (involving 1498 women) in this review. However, only nine of the included studies (with 750 women) reported 24 comparisons of analgesia with other analgesia or placebo and had data that could be included in our meta-analyses. The majority of studies investigated pharmacological analgesics and these were grouped into classes for this review. Non-steroidal anti-inflammatory drugs (NSAIDs) were significantly better than placebo at relieving pain from uterine involution as assessed by their summed pain intensity differences (SPID) (mean difference (MD) 4.34; 95% confidence interval (CI) 2.87 to 5.82; three studies, 204 women) and summed pain relief scores (MD 5.94; 95% CI 3.83 to 8.01; three studies, 204 women). NSAIDS were compared with opioids in one small study of 23 women reporting SPID and summed pain relief and found no difference. A larger study of 127 women found NSAIDs to be significantly better than opioids at reducing pain intensity six hours following study intervention (MD -0.70; 95% CI -1.04 to -0.35). Opioids were compared with placebo in three studies that could be included in meta-analyses; one small study of 23 women reporting SPID and summed pain relief and found no difference. One study of 95 women found no difference in pain intensity six hours following the study intervention. A third study of 108 women found significantly more women in the placebo group reported no pain relief than women in the opioid group (risk ratio 0.10; 95% CI 0.04 to 0.23). Aspirin was significantly better than paracetamol when pain intensity score was assessed six hours after study intervention (MD 0.85; 95% CI 0.29 to 1.41; one study 48 women) at relieving pain from uterine involution. Paracetamol was not better than placebo when pain intensity was assessed six hours after the study intervention in one study of 48 women.

Authors' conclusions

Non-steroidal anti-inflammatory drugs (NSAID) including aspirin were better than placebo at relieving pain from uterine cramping/involution following vaginal birth. NSAIDs were better than paracetamol and paracetamol was not better than placebo, though numbers of participants for these comparisons were small. Data for opioids compared with NSAIDs and opioids compared with placebo were conflicting, with some measures showing similar effect and others indicating NSAIDs were better than opioids and opioids were not better than placebo. There were insufficient data to make conclusions regarding the effectiveness of opioids at relieving pain from uterine cramping/involution.

The median year of publication of included studies was 1981; therefore more research is needed to assess the effectiveness of current pharmacological and non-pharmacological analgesia at relieving pain from uterine cramping/involution following vaginal birth.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Pain relief for after pains (uterine cramping/involution) after the baby's birth

Women may experience cramping pain and discomfort following the birth of their baby as the uterus contracts and returns to its pre-pregnancy size. These after pains are caused by involutionary contractions and usually last for two to three days after childbirth. They are more evident for women who have previously had a baby. Breastfeeding stimulates the uterus to contract and increases the severity of after birth pains. This review is about pain relief for after pains experienced by women following vaginal birth.

Types of analgesia used to relieve the pain include paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs) included aspirin and naproxen, opioids including codeine and non-pharmacological methods such as transcutaneous electrical nerve stimulation (TENS). The results from 18 randomised controlled trials involving 1498 women, of which nine (750 women) had data that could be included in the review meta-analyses, indicated that aspirin and other NSAIDs including naproxen were more effective at relieving uterine cramping pain than paracetamol or a placebo. NSAIDs included naproxen, aspirin, ketorolac and flurbiprofen. Only naproxen is still used in women who are breastfeeding. Aspirin is not recommended for use by breastfeeding women as there is concern that it will be passed to the baby in the breast milk. Codeine was not always more effective than a placebo or NSAIDs in the included studies and can sedate breastfed babies. Women offered codeine for pain relief should be informed about the potential for adverse effects for their babies. Codeine should only be prescribed for breastfeeding women with after birth pain if there is no alternative and their breastfed infants should be closely monitored for sedation and signs of codeine toxicity. Information about the safety of the NSAIDs for breastfeeding women and their babies was limited.

The majority of analyses in this review included only one study with small numbers of participants. The average year of the included studies is 1981 and therefore further research is recommended comparing NSAIDs currently available and known to be safe for women who are breastfeeding and their babies.

 

Resumen

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Antecedentes

Analgesia para el alivio del dolor debido a involución / calambres uterinos después del parto

Las mujeres pueden presentar diferentes tipos de dolor y malestar después del parto que incluyen calambres posteriores al parto asociados con la involución uterina.

Objetivos

Evaluar la efectividad y la seguridad de la analgesia para el alivio del dolor posterior al parto vaginal.

Estrategia de búsqueda

Se hicieron búsquedas en el Registro de Ensayos del Grupo Cochrane de Embarazo y Parto (Cochrane Pregnancy and Childbirth Group) (31 diciembre 2010) y en las listas de referencias de ensayos y artículos de revisión.

Criterios de selección

Todos los ensayos controlados aleatorios publicados y no publicados identificados que compararan dos tipos diferentes de analgesia o analgesia con placebo, o analgesia sin tratamiento, para el alivio de los dolores posteriores al parto vaginal. Los tipos de analgesia incluyeron farmacológica y no farmacológica.

Obtención y análisis de los datos

Dos autores de la revisión evaluaron la calidad de los ensayos y extrajeron los datos de forma independiente.

Resultados principales

En esta revisión se incluyeron 18 ensayos (1498 mujeres). Sin embargo, sólo nueve de los estudios incluidos (750 mujeres) informaron 24 comparaciones de analgesia con otra analgesia o placebo y tuvieron datos que se pudieron incluir en los metanálisis. La mayoría de los estudios investigó los analgésicos farmacológicos y éstos se agruparon en clases para esta revisión. Los fármacos antiinflamatorios no esteroides (AINE) fueron significativamente mejores que placebo para aliviar el dolor de la involución uterina cuando se evaluaron mediante las diferencias de la intensidad del dolor totales (DSIT) (diferencia de medias [DM] 4,34; intervalo de confianza [IC] del 95%: 2,87 a 5,82; tres estudios, 204 mujeres) y las puntuaciones de alivio del dolor totales (DM 5,94; IC del 95%: 3,83 a 8,01; tres estudios, 204 mujeres). Los AINE se compararon con los opiáceos en un estudio pequeño de 23 mujeres que informó las DSIT y las puntuaciones de alivio del dolor totales y no se encontraron diferencias. Un estudio más grande de 127 mujeres encontró que los AINE fueron significativamente mejores que los opiáceos para reducir la intensidad del dolor seis horas después de la intervención de estudio (DM −0,70; IC del 95%: −1,04 a −0,35). Los opiáceos se compararon con placebo en tres estudios que se pudieron incluir en los metanálisis; un estudio pequeño de 23 mujeres informó las DSIT y las puntuaciones de alivio del dolor totales y no encontraron diferencias. Un estudio de 95 mujeres no encontró diferencias en la intensidad del dolor seis horas después de la intervención de estudio. Un tercer estudio de 108 mujeres encontró que significativamente más mujeres del grupo placebo no informaron alivio del dolor en comparación con las mujeres del grupo opiáceo (cociente de riesgos 0,10; IC del 95%: 0,04 a 0,23). La aspirina fue significativamente mejor que el paracetamol cuando la puntuación de intensidad del dolor se evaluó seis horas después de la intervención de estudio (DM 0,85; IC del 95%: 0,29 a 1,41; un estudio 48 mujeres) para aliviar el dolor de la involución uterina. El paracetamol no fue mejor que placebo cuando la intensidad del dolor se evaluó seis horas después de la intervención de estudio en un ensayo de 48 mujeres.

Conclusiones de los autores

Los fármacos antiinflamatorios no esteroides (AINE) incluida la aspirina fueron mejores que placebo para aliviar el dolor debido a involución / calambres uterinos después del parto vaginal. Los AINE fueron mejores que paracetamol y paracetamol no fue mejor que placebo, aunque los números de participantes para estas comparaciones fueron escasos. Los datos de los opiáceos comparados con los AINE y de los opiáceos comparados con placebo fueron contradictorios; algunas medidas mostraron un efecto similar y otras indicaron que los AINE fueron mejores que los opiáceos y que los opiáceos no fueron mejores que placebo. No hubo datos suficientes para establecer conclusiones con respecto a la eficacia de los opiáceos para el alivio del dolor debido a involución / calambres uterinos.

La mediana del año de publicación de los estudios incluidos fue 1981; por lo tanto, se necesitan más investigaciones para evaluar la efectividad de la analgesia farmacológica y no farmacológica actual para aliviar el dolor debido a involución / calambres uterinos después del parto vaginal.

Traducción

Traducción realizada por el Centro Cochrane Iberoamericano