Aspirina (dosis única) para el dolor perineal durante el período posparto temprano
Información
- DOI:
- https://doi.org/10.1002/14651858.CD012129.pub2Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 09 febrero 2017see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Embarazo y parto
- Copyright:
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- Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
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Autores
Contributions of authors
Sujana Molakatalla drafted the first version of the protocol for this review, with Emily Shepherd and Rosalie Grivell making comments and contributing to the final draft.
Sujana Molakatalla and Emily Shepherd assessed studies for inclusion and exclusion; carried out data extraction and assessed the risk of bias of the included trials. Emily Shepherd entered data into RevMan and performed the analyses. Sujana Molakatalla drafted the review with input from both Emily Shepherd (editorial) and Rosalie Grivell (editorial and clinical).
Sources of support
Internal sources
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Robinson Research Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Australia.
External sources
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NHMRC: National Health and Medical Research Council, Australia.
Funding for the Pregnancy and Childbirth Australian and New Zealand Satellite
Declarations of interest
Sujana Molakatalla: none known.
Emily Bain: none known.
Rosalie M Grivell: none known.
Acknowledgements
As part of the pre‐publication editorial process, this review has been commented on by three peers (an editor and two referees who are external to the editorial team), a member of the Pregnancy and Childbirth Group's international panel of consumers and the Group's Statistical Adviser.
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.
We acknowledge the support from the Cochrane Pregnancy and Childbirth editorial team in Liverpool, and the Australian and New Zealand Satellite of Cochrane Pregnancy and Childbirth (funded by the Australian National Health and Medical Research Council (NHMRC)).
Version history
| Published | Title | Stage | Authors | Version |
| 2020 Jul 24 | Aspirin (single dose) for perineal pain in the early postpartum period | Review | Emily Shepherd, Rosalie M Grivell | |
| 2017 Feb 09 | Aspirin (single dose) for perineal pain in the early postpartum period | Review | Sujana Molakatalla, Emily Shepherd, Rosalie M Grivell | |
| 2016 Mar 21 | Aspirin (single dose) for perineal pain in early postpartum period | Protocol | Sujana Molakatalla, Emily Shepherd, Rosalie M Grivell | |
Differences between protocol and review
There are some differences between our published protocol (Molakatalla 2016) and this full review.
Methods/data collection and analysis/assessment of pain ‐ we clarified that our measure was 50% or greater pain relief (our protocol stated 50%). We also clarified equations used for measures of pain in the review.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
- Acute Pain [*drug therapy];
- Anti-Inflammatory Agents, Non-Steroidal [*administration & dosage];
- Aspirin [*administration & dosage];
- Episiotomy [adverse effects];
- Obstetric Labor Complications [*drug therapy];
- Pain, Postoperative [drug therapy];
- *Perineum;
- Placebo Effect;
- Postpartum Period;
- Randomized Controlled Trials as Topic;
- Time Factors;
Medical Subject Headings Check Words
Female; Humans; Pregnancy;
PICO
Study flow diagram
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
Funnel plot of comparison: 1 Aspirin versus placebo for perineal pain, outcome: 1.1 Adequate pain relief as reported by the woman
Funnel plot of comparison: 1 Aspirin versus placebo for perineal pain, outcome: 1.2 Need for additional pain relief
Funnel plot of comparison: 1 Aspirin versus placebo for perineal pain, outcome: 1.3 Maternal adverse effects
Comparison 1 Aspirin versus placebo for perineal pain, Outcome 1 Adequate pain relief as reported by the woman.
Comparison 1 Aspirin versus placebo for perineal pain, Outcome 2 Need for additional pain relief.
Comparison 1 Aspirin versus placebo for perineal pain, Outcome 3 Maternal adverse effects.
Comparison 2 300 mg aspirin versus 600 mg aspirin for perineal pain, Outcome 1 Adequate pain relief as reported by the woman.
Comparison 2 300 mg aspirin versus 600 mg aspirin for perineal pain, Outcome 2 Need for additional pain relief.
Comparison 2 300 mg aspirin versus 600 mg aspirin for perineal pain, Outcome 3 Maternal adverse effects.
Comparison 3 600 mg aspirin versus 1200 mg aspirin for perineal pain, Outcome 1 Adequate pain relief as reported by the woman.
Comparison 3 600 mg aspirin versus 1200 mg aspirin for perineal pain, Outcome 2 Need for additional pain relief.
Comparison 3 600 mg aspirin versus 1200 mg aspirin for perineal pain, Outcome 3 Maternal adverse effects.
Comparison 4 300 mg aspirin versus 1200 mg aspirin for perineal pain, Outcome 1 Adequate pain relief as reported by the woman.
Comparison 4 300 mg aspirin versus 1200 mg aspirin for perineal pain, Outcome 2 Need for additional pain relief.
Comparison 4 300 mg aspirin versus 1200 mg aspirin for perineal pain, Outcome 3 Maternal adverse effects.
| Aspirin compared with placebo for perineal pain in the early postpartum period | ||||||
| Patient or population: women with perineal pain in the early postpartum period Settings: 17 RCTs published from 1967 to 1997 (11 RCTs conducted in USA, 3 in Venezuela, 1 each in Belgium, Canada and India) Intervention: aspirin (single dose) Comparison: placebo | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Quality of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Placebo | Aspirin | |||||
| Adequate pain relief as reported by the woman (4 to 8 hours) | Study population | RR 2.03 (1.69, 2.42) | 1001 (13 RCTs) | ⊕⊕⊝⊝ | ||
| 253 per 1000 | 513 per 1000 (427 to 612) | |||||
| Need for additional pain relief (4 to 8 hours) | Study population | RR 0.25 (0.17, 0.37) | 744 (10 RCTs) | ⊕⊝⊝⊝ | ||
| 267 per 1000 | 67 per 1000 (45 to 99) | |||||
| Maternal adverse effects (4 to 8 hours) | Study population | RR 1.08 (0.57, 2.06) | 1067 (14 RCTs) | ⊕⊝⊝⊝ | ||
| 27 per 1000 | 29 per 1000 (15 to 55) | |||||
| Neonatal adverse effects | (0 RCTs) | Not reported by any of the included RCTs | ||||
| Perineal pain at six weeks postpartum | (0 RCTs) | Not reported by any of the included RCTs | ||||
| *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). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1Study limitations: downgraded two levels due to the serious risk of bias 2Publication bias: downgraded by one level based on visual inspection of funnel plot which indicates likely publication bias 3Imprecision: downgraded one level due to few events and wide 95% CI around the pooled estimate which includes no effect | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Adequate pain relief as reported by the woman Show forest plot | 13 | 1001 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.03 [1.69, 2.42] |
| 1.1 300 mg aspirin | 1 | 53 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.6 [0.36, 18.88] |
| 1.2 500 to 650 mg aspirin | 11 | 800 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.98 [1.64, 2.39] |
| 1.3 900 mg aspirin | 1 | 40 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.83 [0.84, 3.99] |
| 1.4 1200 mg aspirin | 3 | 108 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.75 [1.25, 6.06] |
| 2 Need for additional pain relief Show forest plot | 10 | 744 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.25 [0.17, 0.37] |
| 2.1 300 mg aspirin | 1 | 53 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.16 [0.03, 0.79] |
| 2.2 500 to 650 mg aspirin | 9 | 569 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.27 [0.17, 0.41] |
| 2.3 900 mg aspirin | 1 | 40 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.14 [0.01, 2.60] |
| 2.4 1200 mg aspirin | 2 | 82 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.20 [0.06, 0.70] |
| 3 Maternal adverse effects Show forest plot | 14 | 1067 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.08 [0.57, 2.06] |
| 3.1 300 mg aspirin | 1 | 53 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 3.2 500 to 650 mg aspirin | 13 | 892 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.13 [0.51, 2.53] |
| 3.3 900 mg aspirin | 1 | 40 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.5 [0.55, 11.41] |
| 3.4 1200 mg aspirin | 2 | 82 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.10 [0.01, 1.80] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Adequate pain relief as reported by the woman Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 2 Need for additional pain relief Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 3 Maternal adverse effects Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Adequate pain relief as reported by the woman Show forest plot | 2 | 121 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.85 [0.52, 1.39] |
| 2 Need for additional pain relief Show forest plot | 2 | 121 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.32 [0.30, 5.68] |
| 3 Maternal adverse effects Show forest plot | 2 | 121 | Risk Ratio (M‐H, Fixed, 95% CI) | 3.0 [0.13, 69.52] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Adequate pain relief as reported by the woman Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 2 Need for additional pain relief Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 3 Maternal adverse effects Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
