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Liječenje zastojne dojke tijekom laktacije

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Información

DOI:
https://doi.org/10.1002/14651858.CD006946.pub3Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 28 junio 2016see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:
  1. Grupo Cochrane de Embarazo y parto

Copyright:
  1. Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Contraer

Autores

  • Lindeka Mangesi

    Correspondencia a: Victoria Hospital, Alice, South Africa

    [email protected]

  • Irena Zakarija‐Grkovic

    Departments of Family Medicine and Public Health, University of Split School of Medicine, Split, Croatia

Contributions of authors

Lindeka Mangesi and Irena Zakarija‐Grkovic independently assessed study eligibility and carried out data extraction and assessment of risk of bias. The two review authors equally contributed to the update of this review.

Sources of support

Internal sources

  • Cochrane Croatia, Croatia.

    Irena Zakarija‐Grkovic was supported by Cochrane Croatia and the Campbell and Cochrane Equity Methods Group

External sources

  • South African Cochrane Centre, South Africa.

    Lindeka Mangesi was supported by South African Cochrane Centre.

Declarations of interest

None known.

Acknowledgements

This project was supported by the National Institute for Health Research, via Cochrane Infrastructure funding to Cochrane Pregnancy and Childbirth. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health.

Lindeka Mangesi was awarded a fellowship by the South African Cochrane Centre through a grant received from the Effective Health Care Research Consortium www.evidence4health.org, which is funded by UKaid from the UK Government for International Development.

We acknowledge Therese Dowswell for her contribution in the initial review.

We thank the following members of the Campbell and Cochrane Equity Methods Group: Peter Tugwell, Jordi Pardo, Elizabeth Tanjong‐Ghogomu and George Wells for their assistance with interpreting data and assessment of risk of bias. In particular we would like to acknowledge Siavash Ghazvinian for translating the Farsi report and assisting with data extraction.

We acknowledge Livia Puljak, from Cochrane Croatia, for her assistance with final editing of the review.

We thank the editorial staff and peer reviewers of the Cochrane Pregnancy and Childbirth Group for their patience, advice, support and guidance in improving the quality of this review.

Version history

Published

Title

Stage

Authors

Version

2020 Sep 18

Treatments for breast engorgement during lactation

Review

Irena Zakarija-Grkovic, Fiona Stewart

https://doi.org/10.1002/14651858.CD006946.pub4

2016 Jun 28

Treatments for breast engorgement during lactation

Review

Lindeka Mangesi, Irena Zakarija‐Grkovic

https://doi.org/10.1002/14651858.CD006946.pub3

2010 Sep 08

Treatments for breast engorgement during lactation

Review

Lindeka Mangesi, Therese Dowswell

https://doi.org/10.1002/14651858.CD006946.pub2

2008 Jan 23

Treatments for breast engorgement during lactation

Protocol

Lindeka Mangesi, Gibson Muzonzini

https://doi.org/10.1002/14651858.CD006946

Differences between protocol and review

The protocol Methods section has been updated. The following outcomes, which were not in the original protocol, were added because they had not been adequately addressed in the previous version of the review, and were felt to be important for women with breast engorgement.

Primary outcomes: breast pain, breast induration/hardness, breast swelling, breast engorgement.

Secondary outcome: pyrexia (as defined by trial authors) was added to replace temperature higher than 38 degrees celsius.

Methods for GRADE assessment of the quality of the evidence have been added for this update and a 'Summary of findings' table has been incorporated.

Due to the lack of trials and the way in which outcomes were assessed and reported in these trials we were unable to carry out some of our pre‐specified methods.

Data were not presented in a way that allowed us to include them in the data tables. We were unable to combine results in meta‐analyses or investigate subgroup analysis and assessment of heterogeneity. The small number of included studies with diverse interventions prevented us from carrying out meaningful sensitivity analysis.

For this version of the review we did not identify any cluster‐randomised trials.

Notes

This review was not updated earlier due to scarce availability of new evidence; hence conducting a review earlier may have been unnecessary and wasteful.

Keywords

MeSH

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 1

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 2

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 Acupuncture versus usual care, Outcome 1 Breast abscess.
Figuras y tablas -
Analysis 1.1

Comparison 1 Acupuncture versus usual care, Outcome 1 Breast abscess.

Comparison 1 Acupuncture versus usual care, Outcome 2 Lowest Severity Index score (day 5) (combined measurement of breast erythema, tension and pain).
Figuras y tablas -
Analysis 1.2

Comparison 1 Acupuncture versus usual care, Outcome 2 Lowest Severity Index score (day 5) (combined measurement of breast erythema, tension and pain).

Comparison 1 Acupuncture versus usual care, Outcome 3 Pyrexia (advised to take antipyrexials).
Figuras y tablas -
Analysis 1.3

Comparison 1 Acupuncture versus usual care, Outcome 3 Pyrexia (advised to take antipyrexials).

Comparison 2 Cabbage leaf extract versus placebo, Outcome 1 Breast engorgement (Hill and Humenich Breast engorgement scale).
Figuras y tablas -
Analysis 2.1

Comparison 2 Cabbage leaf extract versus placebo, Outcome 1 Breast engorgement (Hill and Humenich Breast engorgement scale).

Comparison 2 Cabbage leaf extract versus placebo, Outcome 2 Breast pain (Bourbonaise pain scale).
Figuras y tablas -
Analysis 2.2

Comparison 2 Cabbage leaf extract versus placebo, Outcome 2 Breast pain (Bourbonaise pain scale).

Comparison 3 Gua‐Sha therapy versus hot packs and massage, Outcome 1 Breast engorgement ‐ 5‐minute post‐intervention (Subjective Breast Engorgement Scale).
Figuras y tablas -
Analysis 3.1

Comparison 3 Gua‐Sha therapy versus hot packs and massage, Outcome 1 Breast engorgement ‐ 5‐minute post‐intervention (Subjective Breast Engorgement Scale).

Comparison 3 Gua‐Sha therapy versus hot packs and massage, Outcome 2 Breast pain ‐ 5‐minute post‐intervention (Subjective Breast Engorgement Scale).
Figuras y tablas -
Analysis 3.2

Comparison 3 Gua‐Sha therapy versus hot packs and massage, Outcome 2 Breast pain ‐ 5‐minute post‐intervention (Subjective Breast Engorgement Scale).

Comparison 3 Gua‐Sha therapy versus hot packs and massage, Outcome 3 Breast discomfort ‐ 5‐minute post‐intervention (Subjective Breast Engorgement Scale).
Figuras y tablas -
Analysis 3.3

Comparison 3 Gua‐Sha therapy versus hot packs and massage, Outcome 3 Breast discomfort ‐ 5‐minute post‐intervention (Subjective Breast Engorgement Scale).

Comparison 4 Ultrasound versus sham treatment, Outcome 1 Analgesic requirement.
Figuras y tablas -
Analysis 4.1

Comparison 4 Ultrasound versus sham treatment, Outcome 1 Analgesic requirement.

Comparison 5 Protease complex versus placebo, Outcome 1 Pain not improved.
Figuras y tablas -
Analysis 5.1

Comparison 5 Protease complex versus placebo, Outcome 1 Pain not improved.

Comparison 5 Protease complex versus placebo, Outcome 2 Breast swelling not improved.
Figuras y tablas -
Analysis 5.2

Comparison 5 Protease complex versus placebo, Outcome 2 Breast swelling not improved.

Comparison 5 Protease complex versus placebo, Outcome 3 Overall rating of recovery (no change or worse).
Figuras y tablas -
Analysis 5.3

Comparison 5 Protease complex versus placebo, Outcome 3 Overall rating of recovery (no change or worse).

Comparison 6 Oxytocin versus placebo, Outcome 1 Symptoms not subsided after three days of treatment.
Figuras y tablas -
Analysis 6.1

Comparison 6 Oxytocin versus placebo, Outcome 1 Symptoms not subsided after three days of treatment.

Comparison 7 Serrapeptase versus placebo, Outcome 1 Slight or no improvement in breast engorgement.
Figuras y tablas -
Analysis 7.1

Comparison 7 Serrapeptase versus placebo, Outcome 1 Slight or no improvement in breast engorgement.

Comparison 7 Serrapeptase versus placebo, Outcome 2 Slight or no improvement in breast swelling.
Figuras y tablas -
Analysis 7.2

Comparison 7 Serrapeptase versus placebo, Outcome 2 Slight or no improvement in breast swelling.

Comparison 7 Serrapeptase versus placebo, Outcome 3 Slight or no improvement in breast pain.
Figuras y tablas -
Analysis 7.3

Comparison 7 Serrapeptase versus placebo, Outcome 3 Slight or no improvement in breast pain.

Summary of findings for the main comparison. Cabbage cream for breast engorgement during lactation

Cabbage cream for breast engorgement during lactation

Patient or population: women with breast engorgement during lactation
Settings: Royal Darwin and Darwin Private Hospital, Australia
Intervention: cabbage cream

Comparison: placebo

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Cabbage cream

Breast pain
Bourbonaise pain scale

The mean breast pain in the intervention groups was
0.4 higher
(0.67 lower to 1.47 higher)

39
(1 study)

⊕⊕⊝⊝

low1,2

Higher score indicates more pain ‐ Bourbonaise pain scale ranks pain on a scale from 0 to 10, with 0 representing no pain and 10 representing excruciating pain.

Breast induration/hardness

This outcome was not reported in the trial.

Breast swelling

This outcome was not reported in the trial.

Breast engorgement
Hill and Humenich Breast engorgement scale
Follow‐up: mean 4 days

The mean engorgement in the intervention groups was
0.2 higher
(0.18 lower to 0.58 higher)

39
(1 study)

⊕⊕⊝⊝

low1,2

Higher score indicates more engorgement ‐ Hill and Humenich Breast engorgement scale ranks engorgement on a scale from 0 to 6, with 0 representing soft, no change in breasts and 6 representing very firm, very tender.

Analgesic requirement

This outcome was not reported in the trial.

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 The number of participants was even smaller than the pre‐determined sample size.
2 Limitations in study design due to a significant imbalance in primiparas at baseline (high risk of bias for other bias).

Figuras y tablas -
Summary of findings for the main comparison. Cabbage cream for breast engorgement during lactation
Comparison 1. Acupuncture versus usual care

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Breast abscess Show forest plot

1

210

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.04, 1.01]

2 Lowest Severity Index score (day 5) (combined measurement of breast erythema, tension and pain) Show forest plot

1

210

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.70, 0.99]

3 Pyrexia (advised to take antipyrexials) Show forest plot

1

210

Risk Ratio (M‐H, Fixed, 95% CI)

0.82 [0.72, 0.94]

Figuras y tablas -
Comparison 1. Acupuncture versus usual care
Comparison 2. Cabbage leaf extract versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Breast engorgement (Hill and Humenich Breast engorgement scale) Show forest plot

1

39

Mean Difference (IV, Fixed, 95% CI)

0.20 [‐0.18, 0.58]

2 Breast pain (Bourbonaise pain scale) Show forest plot

1

39

Mean Difference (IV, Fixed, 95% CI)

0.40 [‐0.67, 1.47]

Figuras y tablas -
Comparison 2. Cabbage leaf extract versus placebo
Comparison 3. Gua‐Sha therapy versus hot packs and massage

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Breast engorgement ‐ 5‐minute post‐intervention (Subjective Breast Engorgement Scale) Show forest plot

1

54

Mean Difference (IV, Random, 95% CI)

‐2.42 [‐2.98, ‐1.86]

2 Breast pain ‐ 5‐minute post‐intervention (Subjective Breast Engorgement Scale) Show forest plot

1

54

Mean Difference (IV, Fixed, 95% CI)

‐2.01 [‐2.60, ‐1.42]

3 Breast discomfort ‐ 5‐minute post‐intervention (Subjective Breast Engorgement Scale) Show forest plot

1

54

Mean Difference (IV, Fixed, 95% CI)

‐2.33 [‐2.81, ‐1.85]

Figuras y tablas -
Comparison 3. Gua‐Sha therapy versus hot packs and massage
Comparison 4. Ultrasound versus sham treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Analgesic requirement Show forest plot

1

45

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.63, 1.51]

Figuras y tablas -
Comparison 4. Ultrasound versus sham treatment
Comparison 5. Protease complex versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain not improved Show forest plot

1

59

Risk Ratio (M‐H, Fixed, 95% CI)

0.17 [0.04, 0.74]

2 Breast swelling not improved Show forest plot

1

59

Risk Ratio (M‐H, Fixed, 95% CI)

0.34 [0.15, 0.79]

3 Overall rating of recovery (no change or worse) Show forest plot

1

59

Risk Ratio (M‐H, Fixed, 95% CI)

0.26 [0.12, 0.56]

Figuras y tablas -
Comparison 5. Protease complex versus placebo
Comparison 6. Oxytocin versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Symptoms not subsided after three days of treatment Show forest plot

1

45

Risk Ratio (M‐H, Fixed, 95% CI)

3.13 [0.68, 14.44]

Figuras y tablas -
Comparison 6. Oxytocin versus placebo
Comparison 7. Serrapeptase versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Slight or no improvement in breast engorgement Show forest plot

1

70

Risk Ratio (M‐H, Fixed, 95% CI)

0.36 [0.14, 0.88]

2 Slight or no improvement in breast swelling Show forest plot

1

70

Risk Ratio (M‐H, Fixed, 95% CI)

0.75 [0.36, 1.55]

3 Slight or no improvement in breast pain Show forest plot

1

70

Risk Ratio (M‐H, Fixed, 95% CI)

0.56 [0.21, 1.49]

Figuras y tablas -
Comparison 7. Serrapeptase versus placebo