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Intervention Review

Local cooling for relieving pain from perineal trauma sustained during childbirth

  1. Christine E East1,*,
  2. Lisa Begg2,
  3. Naomi E Henshall3,
  4. Paul Marchant4,
  5. Karen Wallace5

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 17 OCT 2007

Assessed as up-to-date: 10 JUL 2007

DOI: 10.1002/14651858.CD006304.pub2

How to Cite

East CE, Begg L, Henshall NE, Marchant P, Wallace K. Local cooling for relieving pain from perineal trauma sustained during childbirth. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD006304. DOI: 10.1002/14651858.CD006304.pub2.

Author Information

  1. 1

    University of Melbourne, Department of Obstetrics & Gynaecology, Parkville, Victoria, Australia

  2. 2

    Royal Women's Hospital, Maternal and Fetal Medicine, Carlton, Victoria, Australia

  3. 3

    Royal Hospital for Women, Delivery Suite, Randwick, New South Wales, Australia

  4. 4

    Leeds Metropolitan University, Innovation North , Leeds, UK

  5. 5

    Mater Health Services, Nursing Research Centre including QLD Centre for Evidence Based Nursing & Midwifery (a collaborating centre of The Joanna Briggs Institute)., Raymond Terrace, South Brisbane. Q, Australia

*Christine E East, Department of Obstetrics & Gynaecology, University of Melbourne, Royal Women's Hospital, Crn of Grattan St and Flemington Road, Parkville, Victoria, 3052, Australia. eastc@unimelb.edu.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 17 OCT 2007

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Abstract

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

Background

Perineal trauma is common during childbirth and may be painful. Contemporary maternity practice includes offering women numerous forms of pain relief, including the local application of cooling treatments.

Objectives

To evaluate the effectiveness and side effects of localised cooling treatments compared with no treatment, other forms of cooling treatments and non-cooling treatments.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2007), CINAHL (1982 to January 2007) and contacted experts in the field.

Selection criteria

Published and unpublished randomised and quasi-randomised trials (RCTs) that compared localised cooling treatment applied to the perineum with no treatment or other treatments applied to relieve pain related to perineal trauma sustained during childbirth.

Data collection and analysis

At least two independent authors performed data extraction for each study. Analyses were performed on an intention-to-treat basis where data allowed. We sought additional information from the authors of three trials.

Main results

Seven published RCTs were included, comparing local cooling treatments (ice packs, cold gel pads or cold/iced baths) with no treatment, hamamelis water (witch hazel), pulsed electromagnetic energy (PET), hydrocortisone/pramoxine foam [Epifoam] or warm baths. The RCTs reported on a total of 859 women. Ice packs provided improved pain relief 24 to 72 hours after birth compared with no treatment (risk ratio (RR) 0.61, 95% confidence interval (CI) 0.41 to 0.91). Women preferred the utility of the gel pads compared with ice packs or no treatment, although no differences in pain relief were detected between the treatments. None of our comparisons of treatments resulted in differences detected in perineal oedema or bruising. Women reported more pain (RR 5.60, 95% CI 2.35 to 13.33) and used more additional analgesia (RR 4.00, 95% CI 1.44 to 11.13) following the application of ice packs compared with PET.

Authors' conclusions

There is only limited evidence to support the effectiveness of local cooling treatments (ice packs, cold gel pads, cold/iced baths) applied to the perineum following childbirth to relieve pain.

 

Plain language summary

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

Local cooling for relieving pain from perineal trauma sustained during childbirth

Perineal tears or cuts are common when having a baby. Women often use a number of methods to relieve the pain, including cold baths, ice or cold packs on the area. Seven studies including 859 women compared cooling treatments such as ice, cold gel pads, or cold bath with no treatment, or other treatments. One study found that women reported less pain 24 to 72 hours after giving birth when they used the ice packs, rather than when they had no treatment. There is only a small amount of evidence of how safe and effective cooling treatments are to relieve perineal pain.

 

摘要

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

背景

使用局部冷敷緩解生產時持續會陰創傷疼痛

會陰創傷(Perineal trauma)在生產時常見,會感覺疼痛。目前的作法包括提供各種疼痛緩解方式給孕婦,包括局部冷敷治療。

目標

評估局部冷敷的效果和副作用,和無治療、其他冷敷治療和非冷敷治療等比較。

搜尋策略

我們搜尋Cochrane Pregnancy和Childbirth Group's Trials Register (2007年1月)、CINAHL (1982年2007年1月),以及和此領域之專家聯繫。

選擇標準

已發表和未發表的隨機與半隨機試驗,比較會陰部局部冷敷治療和無治療、或緩解生產時持續會陰創傷的其他治療方式。

資料收集與分析

至少2位獨立作者進行每篇研究的資料摘錄。以治療意向分析為基礎分析適合的資料。我們從3篇試驗的作者尋求其他資訊。

主要結論

納入7篇已發表的隨機對照試驗,比較局部冷敷治療(冰敷、冷凝膠墊、或冷水/冰水浴)、無治療、金縷梅水、脈衝能量治療(pulsed electromagnetic energy (PET))、 hydrocortisone/pramoxine泡沫[Epifoam]或溫水浴。隨機對照試驗共納入859名婦女。相較於無治療,冰敷可改善產後24 – 72小時的疼痛緩解(RR為0.61, 95% CI為0.41 – 0.91)。相較於無治療或冰敷,婦女偏好使用冷凝膠墊,不過這些治療之間的疼痛緩解沒有差異。我們比較的這些治療方式,在會陰水腫或瘀傷方面沒有差異。相較於脈衝能量治療,使用冰敷的婦女有較多疼痛(RR為5.60, 95% CI為2.35 – 13.33)且使用較多止痛藥(RR為4.00, 95% CI為1.44 – 11.13)。

作者結論

支持使用局部冷敷治療(冰敷、冷凝膠墊、冷水/冰水浴)緩解產後會陰疼痛的證據相當有限。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

生產時持續會陰創傷使用局部冷敷緩解疼痛。生產時,常會發生會陰拉扯或切割,有多種方式用來幫助婦女緩解此一疼痛,包括冷水浴、局部冰敷或冷敷。7篇研究(859名婦女)比較冷敷治療如冰敷、冷凝膠墊、冷水浴和無治療或其他治療。1篇研究發現,冰敷可改善產後24 – 72小時的疼痛緩解,若無治療則否。有關冷敷治療緩解會陰疼痛之效果和安全性的證據有限。