Treatments for breast engorgement during lactation

Lindeka Mangesi; Irena Zakarija‐Grkovic

doi:10.1002/14651858.CD006946.pub3

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Figure 1

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

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Figure 2

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

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Analysis 1.1

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

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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).

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Analysis 1.3

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

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Analysis 2.1

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

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Analysis 2.2

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

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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).

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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).

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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).

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Analysis 4.1

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

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Analysis 5.1

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

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Analysis 5.2

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

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Analysis 5.3

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

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Analysis 6.1

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

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Analysis 7.1

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

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Analysis 7.2

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

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Analysis 7.3

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

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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)	⊕⊕⊝⊝ low^1,2	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)	⊕⊕⊝⊝ low^1,2	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).

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

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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]

Comparison 1. Acupuncture versus usual care

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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]

Comparison 2. Cabbage leaf extract versus placebo

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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]

Comparison 3. Gua‐Sha therapy versus hot packs and massage

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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]

Comparison 4. Ultrasound versus sham treatment

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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]

Comparison 5. Protease complex versus placebo

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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]

Comparison 6. Oxytocin versus placebo

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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]

Comparison 7. Serrapeptase versus placebo

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