Therapeutic Ultrasound Alone and Associated with Lymphatic Drainage in Women with Breast Engorgement: A Clinical Trial.

Introduction: Breast engorgement (BE) is a problem that affects many women, especially in the first days of breastfeeding, producing inflammatory symptoms. Nonpharmacological therapies are inexpensive, safe, and can produce symptom relief. Objective: This study aims to analyze the safety of therapeutic ultrasound regarding possible risks of overheating and the effects of its use alone and associated with lymphatic drainage (LD) in women. Material and Methods: Effectiveness is measured through thermography, visual analog scale, and six-point scale of BE. This is a nonrandomized clinical trial with a sample of 34 in the ultrasound group (G1), 28 in the ultrasound and LD group (G2), and 37 in the control group (G3). Results: The mean reduction for engorgement was 1.3 ± 0.8 to G1, 1.4 ± 1.0 to G2, and 1.2 ± 0.9 to G3 according to the six-point scale. The mean reduction for pain level was 3.6 ± 2.1 to G1, 4.0 ± 3.1 to G2, and 4.0 ± 2.2 to G3 according to the visual analogue scale. Conclusion: It was observed that all therapies were effective in reducing the level of engorgement, according to the six-point scale. However, combined ultrasound and LD therapy has been shown to be more effective in reducing the level of pain. Brazilian Registry of Clinical Trials (RBR-6btb6zz).

Physical therapy intervention for breast symptoms in lactating women: a randomized controlled trial.

BACKGROUND: Therapeutic ultrasound, education, and massage are the most common physical therapy interventions provided to mothers with breast symptoms. However, there is insufficient evidence on the effectiveness of the combination of these interventions. This study aimed to explore the effects of the combination of therapeutic ultrasound, education, and massage on breast symptoms in lactating women. METHODS: This study was a single-blind randomized controlled trial. Postpartum lactating women aged from 21 to 45 with breast symptoms were recruited and randomly allocated to one of three groups (ultrasound group, sham group, and usual care group). The severity of breast symptoms (pain, redness, lump, general malaise), breast engorgement, breast hardness, body temperature, breast temperature, and milk volume were assessed at baseline (T1), immediately post-intervention (T2), and at 3 months following baseline (T3). RESULTS: A total of 37 participants were included in the study (ultrasound group n = 12; sham group n = 12; usual care n = 13). The severity of breast symptoms (i.e., pain, lump, and general malaise) as well as breast engorgement, were significantly improved in the ultrasound group at T2 when compared to T1, and these improvements were sustained at T3. The severity of breast engorgement was significantly lower in the ultrasound group when compared to the usual care group at T2. However, no statistically significant differences were found between the ultrasound and sham groups for all outcomes at any assessment time points. CONCLUSIONS: Physical therapy interventions may be beneficial in relieving breast symptoms in lactating women. Larger randomized controlled trials are needed to confirm the findings of this study. TRIAL REGISTRATION: ClinicalTrials.gov (NCT04569136); Date of registration: 29/09/2020.

The effect of pestle acupuncture for patients with lactation insufficiency after cesarean section: Study protocol for a randomized controlled trial.

INTRODUCTION: Cesarean section is a common operation in obstetrics, and the incidence of insufficient breast milk is high in parturients undergoing cesarean section. Studies have shown that acupuncture or massage at related acupoints can promote the secretion and excretion of milk. These external treatments are quick, safe, and effective. On the other hand, they can avoid the potential risk of changes in milk composition that may be caused by the use of drugs. Pestle needle therapy is a new branch of traditional acupuncture, and pestle needle operation does not need to break the skin. The pestle needle has good clinical efficacy and safety in cervical spondylosis, insomnia, fatigue, depression, and so on, but few studies have focused on the effect of pestle acupuncture for patients with lactation insufficiency after cesarean section. This study aims to determine whether pestle needle therapy is effective and safe in the treatment of postpartum milk deficiency. METHODS: This is a 2 parallel-group, assessor-blinded, randomized controlled trial.128 patients with lactation insufficient after cesarean section will be recruited and randomly divided into control group and the pestle needle group in a 1:1 ratio. The control group will receive routine nursing care of milk deficiency. In the pestle needle group, pestle needles will be used to operate on the acupoints such as bilateral Shao ze (S11), bilateral Ru gen (ST18), Dan zhong (DU14), 8 array acupoints of Shen dao (DU11) and so on. It will be operated once a day for 5 days. The primary outcomes are milk yield, degree of breastfilling, degree of milk siltation and other milk deficiency symptom, and serum prolactin. Secondary outcomes include syndrome of traditional Chinese medicine, such as facial expression, fatigue, loss of appetite, and so on. DISCUSSION: Pestle needle therapy based on acupoint and meridian theory may increase milk secretion and excretion, which will provide a new intervention means to promote breastfeeding and have great significance to guide clinical treatment. TRIAL REGISTRATION NUMBER: ChiCTR2000039752.

[Exploration on the acupoint selection rule for the treatment of postpartum hypogalactia with acupuncture and moxibustion based on the set visualization analysis system].

Based on the set visualization analysis system and Apriori algorithm, the acupoint selection rule for the treatment of postpartum hypogalactia with acupuncture and moxibustion was explored. The clinical research articles relevant with postpartum hypogalactia treated with acupuncture and moxibustion were retrieved from CNKI, Wanfang and VIP databases till July 15, 2019 since the database establishment. According to the inclusion and exclusion criteria, the articles were screened and the acupoint prescriptions were extracted. On the base of the set visualization analysis system and Apriori algorithm, the characteristics of acupoints and the common acupoint combination were analyzed for the treatment of postpartum hypogalactia with acupuncture and moxibustion. Totally, 120 articles are included and 72 acupoints are extracted for the treatment of postpartum hypogalactia with acupuncture and moxibustion, of which, the conception vessel and the stomach meridian of foot-yangming are the most commonly used and the combination of Danzhong (CV 17), Rugen (ST 18), Zusanli (ST 36), Shaoze (SI 1) and Taichong (LR 3) is of the high frequency. The analyses of set visualization, acupoint association rule and acupoint combination network consistently indicate that the above mentioned 5 acupoints are the basic combination for the treatment of postpartum hypogalactia with acupuncture and moxibustion, co-acting on tonifying and nourishing qi and blood, smoothing liver qi and relieving stagnation, activating circulation and promoting lactation. This combination effectively treats postpartum hypogalactia caused by the source insufficiency of transformation of qi and blood and qi stagnation.

Treatments for breast engorgement during lactation.

BACKGROUND: Engorgement is the overfilling of breasts with milk, often occurring in the early days postpartum. It results in swollen, hard, painful breasts and may lead to premature cessation of breastfeeding, decreased milk production, cracked nipples and mastitis. Various treatments have been studied but little consistent evidence has been found on effective interventions. OBJECTIVES: To determine the effectiveness and safety of different treatments for engorgement in breastfeeding women. SEARCH METHODS: On 2 October 2019, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP), and reference lists of retrieved studies. SELECTION CRITERIA: All types of randomised controlled trials and all forms of treatment for breast engorgement were eligible. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for eligibility, extracted data, conducted 'Risk of bias' assessment and assessed the certainty of evidence using GRADE. MAIN RESULTS: For this udpate, we included 21 studies (2170 women randomised) conducted in a variety of settings. Six studies used individual breasts as the unit of analysis. Trials examined a range of interventions: cabbage leaves, various herbal compresses (ginger, cactus and aloe, hollyhock), massage (manual, electromechanical, Oketani), acupuncture, ultrasound, acupressure, scraping therapy, cold packs, and medical treatments (serrapeptase, protease, oxytocin). Due to heterogeneity, meta-analysis was not possible and data were reported from single trials. Certainty of evidence was downgraded for limitations in study design, imprecision and for inconsistency of effects. We report here findings from key comparisons. Cabbage leaf treatments compared to control For breast pain, cold cabbage leaves may be more effective than routine care (mean difference (MD) -1.03 points on 0-10 visual analogue scale (VAS), 95% confidence intervals (CI) -1.53 to -0.53; 152 women; very low-certainty evidence) or cold gel packs (-0.63 VAS points, 95% CI -1.09 to -0.17; 152 women; very low-certainty evidence), although the evidence is very uncertain. We are uncertain about cold cabbage leaves compared to room temperature cabbage leaves, room temperature cabbage leaves compared to hot water bag, and cabbage leaf extract cream compared to placebo cream because the CIs were wide and included no effect. For breast hardness, cold cabbage leaves may be more effective than routine care (MD -0.58 VAS points, 95% CI -0.82 to -0.34; 152 women; low-certainty evidence). We are uncertain about cold cabbage leaves compared to cold gel packs because the CIs were wide and included no effect. For breast engorgement, room temperature cabbage leaves may be more effective than a hot water bag (MD -1.16 points on 1-6 scale, 95% CI -1.36 to -0.96; 63 women; very low-certainty evidence). We are uncertain about cabbage leaf extract cream compared to placebo cream because the CIs were wide and included no effect. More women were satisfied with cold cabbage leaves than with routine care (risk ratio (RR) 1.42, 95% CI 1.22 to 1.64; 152 women; low certainty), or with cold gel packs (RR 1.23, 95% CI 1.10 to 1.38; 152 women; low-certainty evidence). We are uncertain if women breastfeed longer following treatment with cold cabbage leaves than routine care because CIs were wide and included no effect. Breast swelling and adverse events were not reported. Compress treatments compared to control For breast pain, herbal compress may be more effective than hot compress (MD -1.80 VAS points, 95% CI -2.07 to -1.53; 500 women; low-certainty evidence). Massage therapy plus cactus and aloe compress may be more effective than massage therapy alone (MD -1.27 VAS points, 95% CI -1.75 to -0.79; 100 women; low-certainty evidence). In a comparison of cactus and aloe compress to massage therapy, the CIs were wide and included no effect. For breast hardness, cactus and aloe cold compress may be more effective than massage (RR 0.66, 95% CI 0.51 to 0.87; 102 women; low-certainty evidence). Massage plus cactus and aloe cold compress may reduce the risk of breast hardness compared to massage alone (RR 0.38, 95% CI 0.25 to 0.58; 100 women; low-certainty evidence). We are uncertain about the effects of compress treatments on breast engorgement and cessation of breastfeeding because the certainty of evidence was very low. Among women receiving herbal compress treatment, 2/250 experienced skin irritation compared to 0/250 in the hot compress group (moderate-certainty evidence). Breast swelling and women's opinion of treatment were not reported. Medical treatments compared to placebo Protease may reduce breast pain (RR 0.17, 95% CI 0.04, 0.74; low-certainty evidence; 59 women) and breast swelling (RR 0.34, 95% CI 0.15 to 0.79; 59 women; low-certainty evidence), whereas serrapeptase may reduce the risk of engorgement compared to placebo (RR 0.36, 95% CI 0.14 to 0.88; 59 women; low-certainty evidence). We are uncertain if serrapeptase reduces breast pain or swelling, or if oxytocin reduces breast engorgement compared to placebo, because the CIs were wide and included no effect. No women experienced adverse events in any of the groups receiving serrapeptase, protease or placebo (low-certainty evidence). Breast induration/hardness, women's opinion of treatment and breastfeeding cessation were not reported. Cold gel packs compared to control For breast pain, we are uncertain about the effectiveness of cold gel packs compared to control treatments because the certainty of evidence was very low. For breast hardness, cold gel packs may be more effective than routine care (MD -0.34 points on 1-6 scale, 95% CI -0.60 to -0.08; 151 women; low-certainty evidence). It is uncertain if women breastfeed longer following cold gel pack treatment compared to routine care because the CIs were wide and included no effect. There may be little difference in women's satisfaction with cold gel packs compared to routine care (RR 1.17, 95% CI 0.97 to 1.40; 151 women; low-certainty evidence). Breast swelling, engorgement and adverse events were not reported. AUTHORS' CONCLUSIONS: Although some interventions may be promising for the treatment of breast engorgement, such as cabbage leaves, cold gel packs, herbal compresses, and massage, the certainty of evidence is low and we cannot draw robust conclusions about their true effects. Future trials should aim to include larger sample sizes, using women - not individual breasts - as units of analysis.

[Analysis on the rule of clinical acupoint selection in treatment of puerperal insufficient lactation with acupuncture and moxibustion].

The rule and characteristics of clinical acupoint selection were explored in treatment of puerperal insufficient lactation with acupuncture and moxibustion. The clinical articles on the treatment of puerperal insufficient lactation with acupuncture and moxibustion were retrieved from the databases of CNKI, VIP and Wanfang from the date of establishment to June 1, 2019. The articles were screened in accordance with the inclusion and exclusion criteria. The prescriptions of acupuncture and moxibustion were extracted and normalized. Using Microsoft Excel 2016 software, the use frequency, meridians involved and acupoint distributions were analyzed. Using SPSS Statistics 21.0 software, the cluster and factor analyses were conducted. Totally, 102 articles were included,108 acupoint prescriptions were extracted, 65 acupoitns were designed and the total use frequency was 654 times. The top three acupoints used in treatment of puerperal insufficient lactation were Danzhong (CV 17), Rugen (ST 18) and Shaoze (SI 1). The most frequently involved meridians were the stomach meridian, the conception vessel, the small intestine meridian and the liver meridian. The acupoints were mainly distributed in the chest and four extremities. It was showed in cluster analysis that Rugen (ST 18), Shaoze (SI 1), Zusanli (ST 36) and Danzhong (CV 17) represent 3 clusters and a total of 7 common factors were extracted. The acupoint selection is based on syndrome differentiation in treatment of puerperal insufficient lactation with acupuncture and moxibustion, of which, the local acupoints are predominated and the distal acupoints are combined.

[Effect of electroacupuncture at Shaoze (SI 1) on breast milk volume and composition in postpartum hypogalactia].

OBJECTIVE: To observe the effect of electroacupuncture at Shaoze (SI 1) on breast milk volume and nutrient composition in postpartum hypogalactia. METHODS: A total of 62 women with postpartum hypogalactia were randomized into an observation group (31 cases, 3 cases dropped off) and a control group (31 cases, 3 cases dropped off). Electroacupuncture was exerted at Shaoze (SI 1) in the observation group and at Shangyang (LI 1) in the control group, 10 Hz in frequency, 30 min each time, once a day. The treatment for 5 times as one course and 3 courses of treatment were required totally. Separately, before treatment and at the end of 1 course and 3 courses of treatment, the breast milk volume was measured and the composition was analyzed. The breast milk volume, nutrient composition (lactose, fat and protein), breast milk energy and density were observed in the two groups. After treatment, the clinical effect was compared between the two groups. RESULTS: In the observation group, after 1 course of treatment, the breast milk volume and the values of lactose and protein in the breast milk were increased as compared with those before treatment, the breast milk energy and density were increased as compared with those before treatment (all P<0.05). After 3 courses of treatment, the breast milk volume and the values of nutrient composition (lactose, fat and protein) were improved as compared with those before treatment, and the breast milk energy and density were increased obviously as compared with those before treatment in the observation group (all P<0.05). In the control group, after 1 course and 3 courses of treatment, only breast milk volume was increased obviously as compared with that before treatment (both P<0.05). After 1 course of treatment, the nutrient composition (lactose and protein), breast milk energy and density in the observation group were higher than those in the control group (all P<0.05). After 3 courses of treatment, the levels of breast milk volume, nutrient composition (lactose, fat and protein), breast milk energy and density in the observation group were all higher than those in the control group (all P<0.05). The effective rate was 92.9% (26/28) in the observation group, which was higher than 17.9% (5/28) in the control group (P<0.05). CONCLUSION: Electroacupuncture at Shaozhe (SI 1) increases breast milk volume in patients with postpartum hypogalactia and promotes the production of the nutrient composition in breast milk, as well as the breast milk energy and density.

Effectiveness of breast massage for the treatment of women with breastfeeding problems: a systematic review.

OBJECTIVES: The aim of this systematic review was to identify the effectiveness of breast massage as a treatment for women with breastfeeding problems. More specifically, the objective was to identify if breast massage as an intervention led to less pain or increased milk supply, or assisted in a reduction or resolution of blocked ducts, breast engorgement and mastitis. INTRODUCTION: Breastfeeding protects babies against many illnesses, and the health benefits for women have been well documented. However, breastfeeding rates steadily drop to approximately 15% by six months, which is the World Health Organization's recommended length of time for exclusive breastfeeding. Breastfeeding problems such as blocked ducts, breast engorgement and mastitis are major complications attributing to the decline in breastfeeding rates. Breast massage may relieve pain and resolve symptoms associated with conditions that contribute to discontinued breastfeeding. INCLUSION CRITERIA: This review considered both experimental and epidemiological study designs and included breastfeeding women of any age, parity or geographical location. The types of interventions considered for inclusion were any type of breast massage that was offered to women for breastfeeding problems. Comparators included the usual care provided to women with breastfeeding problems. Primary outcomes of interest were an increase in breast milk supply, reduction of breast pain, and symptom resolution of blocked ducts, engorgement and mastitis. Secondary outcomes included duration of breastfeeding. METHODS: Studies published from 1980 to 2017 in English and Japanese were considered for inclusion in this review. The databases searched with the majority of results included CINAHL, Cochrane Library, Embase, PubMed, Science Direct, Scopus and Web of Science. Search for unpublished studies included Google Scholar, ClinicalTrials.gov and ProQuest Dissertations and Theses. RESULTS: There were six studies included in this review: three randomized controlled trials and three quasi-experimental studies. There was considerable heterogeneity of study outcome measures, and the use of unvalidated tools in many of the studies led to the inability to pool the results. Furthermore, the heterogeneity of the interventions themselves coupled with small sample sizes for each study greatly decreased generalizability of the outcomes and reduced the overall effectiveness of the interventions. However, all included studies reported a reduction in pain regardless of the breast massage technique used. Overall, varying types of breast massage were helpful in reducing immediate pain and resolving symptoms. CONCLUSIONS: Overall, different types of breast massage were reported as effective in reducing immediate pain for the participants. However, the lack of detailed explanation of the breast massage technique and the extensive training needed to undertake the breast massage decrease the ability to replicate the results. These outcomes may be useful for healthcare professionals caring for women with breastfeeding problems. Future research needs include validating a universal measurement tool for breastfeeding problems and the need for more robust randomized controlled trials, particularly in vulnerable groups such as mothers of preterm infants. Longer follow-up periods are also suggested to establish if breast massage impacts breastfeeding duration.

Effect of Herbal Compresses for Maternal Breast Engorgement at Postpartum: A Randomized Controlled Trial.

BACKGROUND: Maternal breast engorgement is one of the most common problems in the postpartum period. There are several alternative treatments, but there have not been any randomized controlled trial studies about the effects of herbal compresses for breast engorgement. OBJECTIVE: The objective is to investigate the effects of herbal compresses for maternal breast engorgement. MATERIALS AND METHODS: A randomized controlled trial was conducted. The postpartum mothers who had breast engorgement were randomly assigned to herbal or hot compress treatments. The breast engorgement pain scores were assessed by visual analog scales pre- and post-treatment. The pain reduction scales of the herbal compress treatments were analyzed and compared with the hot compress treatments. The adverse effects of each treatment were recorded and collected after 24 hours from treatments. RESULTS: The data from 500 postpartum mothers with breast engorgement were available for analyses, 250 from the herbal compress group and 250 from the hot compress group. The baseline characteristics of both groups were similar except baseline breast engorgement pain score (herbal compress group higher than hot compress group). There were statistically significant mean differences of breast engorgement pain before and after treatment between the herbal and hot compress groups. No serious complications were found after treatment from herbal compresses. CONCLUSION: Among the postpartum mothers who had breast engorgement, the herbal compresses could decrease breast engorgement pain. The pain reduction after herbal compresses was found to be greater than with the hot compresses.

[Application of acupoint massage in postpartum hypogalactia in puerpera].

OBJECTIVE: To evaluate the effects of acupoint massage for postpartum hypogalactia in puerpera. METHODS: A total of 60 puerpera of cesarean section were randomized into an observation group and a control group, 30 cases in each one. In the observation group, 2 cases were dropped out. Finally, there were 28 cases in the observation group and 30 cases in the control group. In the control group, the routine nursing after operation in obstetrics department was given, guiding maternal breastfeeding and postpartum health education. In the observation group, on the basis of the treatment as the control group, the corresponding acupoints were selected from the breast related meridians for massage. Acupoint massage was given since the 3rd day after operation, 8:00 am to 9:00 am, once a day, 1 min at one acupoint, continuously for 5 days. The lactation volume, breast filling, galactostasis and milk viscosity were compared in the parturient of the two groups. The clinical therapeutic effects were compared between the two groups. RESULTS: From the 1st to the 2nd days, the differences were not significant in lactation volume, breast filling and galactostasis score between the two groups (all P>0.05). From the 3rd to 5th days, the lactation volume, breast filling and galactostasis score in the observation group were all lower than those in the control group (all P<0.01). The difference in milk viscosity was not significant in the first 4 days between the two groups (all P>0.05). On the 5th day, the score of milk viscosity in the observation group was lower than that in the control group (P<0.01). The cured rate was 64.3% (18/28) in the observation group, which was better than 13.3% (4/30) in the control group (P<0.05). CONCLUSION: Massage at the acupoints from the breast related meridians effectively promotes the lactation secretion in puerpera of postpartum hypogalactia and alleviates breast distention.

Enfoque terapéutico desde la Medicina Natural y Tradicional para la hipogalactia materna / Therapeutic approach from the Natural and Traditional Medicine for the maternal hipogalactia

Se realizó un estudio de investigación-acción con salida a intervención terapéutica (cuanticualitativa), con el objetivo de facilitar el reflejo de bajada de la leche a través del uso de calor local (fomentos tibios) en 64 mujeres recién paridas y hasta los 7 días posteriores al parto en el Hospital General Docente Octavio de la Concepción y de La Pedraja, de Baracoa en el período de estudio de septiembre de 2016 a septiembre de 2017. Algunas de las variables estudiadas fueron: edad materna, escolaridad, ocupación, tiempo de bajada de la leche, ciclo de tratamiento, cantidad de aplicaciones y antecedentes que modifican la lactancia materna exclusiva (LME). Se logró que las mujeres tratadas con la técnica de calor local consiguieran bajada rápida de la leche, solo 4 mujeres necesitaron el uso de otras técnicas de medicina natural y tradicional (MNT)(AU)

An investigation-action study is carried out aiming a therapeutic intervention (quanti qualitative), with the objective of facilitating the reflection of the running of the milk through the use of local heat (lukewarm fomentation) in recently given birth to women and until the 7 days after the childbirth in the Educational General Hospital Octavio de la Concepción y de la Pedraja, of Baracoa in the period of study of September 2016 September 2017. Some of the studied variables are: maternal age, scholarship, occupation, time of the running of the milk, treatment cycle, quantity of applications and antecedents that the LME modifies. It was achieved that the women treated with the technique of local heat to get quick running of the milk, only 4 women needed the use of other techniques of MNT(AU)

Implementation of an education package on breast engorgement aimed at lactation consultants and midwives to prevent conflicting information for postnatal mothers.

AIM: The aim of this evidence-based practice project was to improve local practice in the treatment of breast engorgement in postnatal mothers and to ensure the treatment of engorgement in postnatal mothers is performed according to the best available evidence. METHODS: This evidence-based practice project took place in a 28-bed postnatal ward in a large metropolitan tertiary hospital. Twenty midwives and 20 in-patients were recruited for the project. The project utilized an audit and feedback design. Midwives were asked a series of questions to test their knowledge on engorgement, and mothers were asked questions relating to the breastfeeding and engorgement care they received. The project was conducted in three phases: preparation for quality audit, implementation of best practice and postimplementation audit. RESULTS: Comparison of Audit 1 (preimplementation) and Audit 2 (postimplementation) results shows significant improvements in all eight audit criteria. An increase of 80% was achieved for the criteria 'midwives received formal education on engorgement' on completion of the project. A 20% increase in 'consistency of education regarding latch' was reported by the mothers, and there was a 30% increase in 'information given to mothers on prevention and signs of engorgement'. Sixty-five percent of midwives were able to correctly identify and manage engorgement, a significant improvement from 5% at baseline. CONCLUSION: This evidence-based practice project successfully identified and utilized best practice in the management of breast engorgement care in mothers in our clinical setting. With effective breast engorgement interventions in place, mothers could continue to successfully breastfeed their babies. The major challenges identified during the conduct of the project included: time constraints on the midwives to attend education sessions and to educate mothers on prevention. At the completion of this project, a closer relationship was forged between the lactation consultant team and the midwives in the project setting. This increased the satisfaction and productivity of the midwives, and motivated them to deliver high-quality care, which contributed to an improvement in mother's confidence and reduction in conflicting information.

The Effect of Hollyhock (Althaea officinalis L) Leaf Compresses Combined With Warm and Cold Compress on Breast Engorgement in Lactating Women: A Randomized Clinical Trial.

Breast engorgement affects lactation. The present study was conducted to determine the effect of hollyhock combined with warm and cold compresses on improving breast engorgement in lactating women. Participants included 40 women with breast engorgement divided into intervention and control groups, with participants in both groups being applied routine interventions and warm compress before nursing and a cold compress after nursing; however, the intervention group was also applied hollyhock compress. Both groups received these treatments 6 times during 2 days. The data collected were analyzed in SPSS-16 using a generalized estimating equation. According to the results, a significant difference was observed in the overall breast engorgement severity in the intervention group (P < .001). The severity of breast engorgement was also found to have a significant relationship with time (P < .001). According to the findings, hollyhock leaf compress combined with performing routine interventions for breast engorgement can improve breast engorgement.

Effectiveness of breast massage in the treatment of women with breastfeeding problems: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The aim is to identify the effectiveness of breast massage in the treatment of women with breastfeeding problems. The objectives are to identify if breast massage has been shown to.

Treatments for breast engorgement during lactation.

BACKGROUND: Breast engorgement is a painful condition affecting large numbers of women in the early postpartum period. It may lead to premature weaning, cracked nipples, mastitis and breast abscess. Various forms of treatment for engorgement have been studied but so far little evidence has been found on an effective intervention. OBJECTIVES: This is an update of a systematic review first published by Snowden et al. in 2001 and subsequently published in 2010. The objective of this update is to seek new information on the best forms of treatment for breast engorgement in lactating women. SEARCH METHODS: We identified studies for inclusion through the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2015) and searched reference lists of retrieved studies. SELECTION CRITERIA: Randomised and quasi-randomised controlled trials. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for eligibility, extracted data and conducted 'Risk of bias' assessments. Where insufficient data were presented in trial reports, we attempted to contact study authors and obtain necessary information. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS: In total, we included 13 studies with 919 women. In 10 studies individual women were the unit of analysis and in three studies, individual breasts were the unit of analysis. Four out of 13 studies were funded by an agency with a commercial interest, two received charitable funding, and two were funded by government agencies.Trials examined interventions including non-medical treatments: cabbage leaves (three studies), acupuncture (two studies), ultrasound (one study), acupressure (one study), scraping therapy (Gua Sha) (one study), cold breast-packs and electromechanical massage (one study), and medical treatments: serrapeptase (one study), protease (one study) and subcutaneous oxytocin (one study). The studies were small and used different comparisons with only single studies contributing data to outcomes of this review. We were unable to pool results in meta-analysis and only seven studies provided outcome data that could be included in data and analysis. Non-medical No differences were observed in the one study comparing acupuncture with usual care (advice and oxytocin spray) (risk ratio (RR) 0.50, 95% confidence interval (CI) 0.13 to 1.92; one study; 140 women) in terms of cessation of breastfeeding. However, women in the acupuncture group were less likely to develop an abscess (RR 0.20, 95% CI 0.04 to 1.01; one study; 210 women), had less severe symptoms on day five (RR 0.84, 95% CI 0.70 to 0.99), and had a lower rate of pyrexia (RR 0.82, 95% CI 0.72 to 0.94) than women in the usual care group.In another study with 39 women comparing cabbage leaf extract with placebo, no differences were observed in breast pain (mean difference (MD) 0.40, 95% CI -0.67 to 1.47; low-quality evidence) or breast engorgement (MD 0.20, 95% CI -0.18 to 0.58; low-quality evidence). There was no difference between ultrasound and sham treatment in analgesic requirement (RR 0.98, 95% CI 0.63 to 1.51; one study; 45 women; low-quality evidence). A study comparing Gua-Sha therapy with hot packs and massage found a marked difference in breast engorgement (MD -2.42, 95% CI -2.98 to -1.86; one study; 54 women), breast pain (MD -2.01, 95% CI -2.60 to -1.42; one study; 54 women) and breast discomfort (MD -2.33, 95% CI -2.81 to -1.85; one study; 54 women) in favour of Gua-Sha therapy five minutes post-intervention, though both interventions significantly decreased breast temperature, engorgement, pain and discomfort at five and 30 minutes post-treatment.Results from individual trials that could not be included in data analysis suggested that there were no differences between room temperature and chilled cabbage leaves and between chilled cabbage leaves and gel packs, with all interventions producing some relief. Intermittent hot/cold packs applied for 20 minutes twice a day were found to be more effective than acupressure (P < 0.001). Acupuncture did not improve maternal satisfaction with breastfeeding. In another study, women who received breast-shaped cold packs were more likely to experience a reduction in pain intensity than women who received usual care; however, the differences between groups at baseline, and the failure to observe randomisation, make this study at high risk of bias. One study found a decrease in breast temperature (P = 0.03) following electromechanical massage and pumping in comparison to manual methods; however, the high level of attrition and alternating method of sequence generation place this study at high risk of bias. MedicalWomen treated with protease complex were less likely to have no improvement in pain (RR 0.17, 95% CI 0.04 to 0.74; one study; 59 women) and swelling (RR 0.34, 95% CI 0.15 to 0.79; one study; 59 women) on the fourth day of treatment and less likely to experience no overall change in their symptoms or worsening of symptoms (RR 0.26, 95% CI 0.12 to 0.56). It should be noted that it is more than 40 years since the study was carried out, and we are not aware that this preparation is used in current practice. Subcutaneous oxytocin provided no relief at all in symptoms at three days (RR 3.13, 95% CI 0.68 to 14.44; one study; 45 women).Serrapeptase was found to produce some relief in breast pain, induration and swelling, when compared to placebo, with a fewer number of women experiencing slight to no improvement in overallbreast engorgement, swelling and breast pain.Overall, the risk of bias of studies in the review is high. The overall quality as assessed using the GRADE approach was found to be low due to limitations in study design and the small number of women in the included studies, with only single studies providing data for analysis. AUTHORS' CONCLUSIONS: Although some interventions such as hot/cold packs, Gua-Sha (scraping therapy), acupuncture, cabbage leaves and proteolytic enzymes may be promising for the treatment of breast engorgement during lactation, there is insufficient evidence from published trials on any intervention to justify widespread implementation. More robust research is urgently needed on the treatment of breast engorgement.

Therapeutic Breast Massage in Lactation for the Management of Engorgement, Plugged Ducts, and Mastitis.

BACKGROUND: Many women in developed countries do not meet their breastfeeding goals and wean early because of breast pain. OBJECTIVE: This study aimed to describe clinical response to therapeutic breast massage in lactation (TBML) in the management of engorgement, plugged ducts, and mastitis. METHODS: Breastfeeding women presenting with engorgement, plugged ducts, or mastitis who received TBML as part of their treatment were enrolled (n = 42). Data collected at the initial visit included demographic, history, and exam data pre-TBML and post-TBML. Email surveys sent 2 days, 2 weeks, and 12 weeks following the initial visit assessed pain and breastfeeding complications. A nested case control of engorged mothers (n = 73) was separately enrolled to compare engorgement severity. RESULTS: Reasons for the visit included engorgement (36%), plugged ducts (67%), and mastitis (29%). Cases, compared to controls, were significantly more likely to have severe engorgement (47% vs 7%, P < .001). Initial mean breast pain level among those receiving TBML was 6.4 out of 10. Following TBML, there was significant improvement in both breast (6.4 vs 2.8, P < .001) and nipple pain (4.6 vs 2.8, P = .013). All women reported immediate improvement in their pain level. At the 12-week survey, 65% found the massage treatment very helpful. The majority of the women with a new episode of mastitis or plugged duct during the study follow-up found the techniques learned during the office visit very helpful for home management of these episodes. CONCLUSION: In office, TBML is helpful for the reduction of acute breast pain associated with milk stasis. Mothers find TBML helpful both immediately in-office and for home management of future episodes.

Effects of massage treatment combined with topical cactus and aloe on puerperal milk stasis.

AIM: Puerperal milk stasis is one of the most common puerperal complication that directly affects breastfeeding. Massage treatment with topical cactus and aloe for puerperal milk stasis might be a superior treatment, and it does not affect breastfeeding. METHODS: The intervention group was treated with massages with cactus and aloe cold compresses, and the control group was treated with massage treatment or cactus and aloe cold compresses alone. We evaluated the efficacies of the treatments through comparisons of the feeding patterns, hardness, and pain after treatment between the three groups. RESULTS: We found that breastfeeding rates were significantly increased in the massage combine with combined with cactus and aloe cold compress group (P < 0.05 for both). Breast hardness and pain were reduced to greater extents in massage combine with combined with cactus and aloe cold compress group than in the massage or cold compress group (P < 0.05). CONCLUSIONS: Massage treatment with topical cactus and aloe topical effectively improved the pain status, hard lump of puerperal milk stasis and increase breastfeeding rate.

Uso de galactogogos no manejo da amamentação: revisão integrativa da literatura / Uso de galactogogos en el manejo de la lactancia materna: revisión integradora de la literatura / Use of galactogogues in breastfeeding management: integrative literature review

Objective: Identifying the available evidence in the literature about galactogogues substances (liquids, herbs or foods with properties to increase milk production). Method: an integrative literature review that surveyed the bases BDENF, LILACS and MEDLINE with the descriptors "lactation disorders", "breastfeeding", "galactogogues," in portuguese, english and spanish, until the year 2011. The final sample was formed of 27 articles. Results: the most prevalent galactogogues were: black beer, hydration, hominy, chicken soup, metoclopramide, chlorpromazine, domperidone, fenugreek and fennel. Conclusion: the culture permeates practice of breastfeeding and therefore must be considered by health professionals in guidance and encouragement to breastfeeding...

Objetivo: Identificar as evidências disponíveis na literatura sobre substâncias galactogogas (líquidos, ervas ou alimentos com propriedades de aumentar a produção láctea). Método: revisão integrativa da literatura que pesquisou as bases BDENF, LILACS e MEDLINE com os descritores: “transtornos da lactação”,“aleitamento materno”, “galactogogos”, em português, inglês e espanhol, até o ano 2011. A amostra final foi de 27 artigos. Resultados: os galactogogos de maior prevalência foram: a cerveja preta, a hidratação, a canjica, a canja de galinha, a metoclopramida, a clorpromazina, a domperidona, o feno-grego e o funcho. Conclusão: o universo cultural permeia a prática do aleitamento materno e, portanto, deve ser contemplado pelos profissionais de saúde na orientação e no incentivo à amamentação...

Objetivo: Identificar las evidencias disponibles en la literatura sobre las sustancias galactogogas (líquidos, hierbas o alimentos con propiedades para aumentar la producción de leche). Método: es una revisión integradora de la literatura que examino las bases BDENF, LILACS y MEDLINE utilizando los descriptores: "trastornos de la lactancia", "lactancia materna", "galactogogos" en portugués, inglés y español, hasta el año 2011. La muestra final fue de 27 artículos. Resultados: los galactogogos más prevalentes fueron: la cerveza negra, la hidratación, sémola de maíz, sopa de pollo, metoclopramida, clorpromazina, domperidona, fenogreco y el hinojo. Conclusión: el universo cultural impregna la práctica de la lactancia materna y por lo tanto deben ser considerados por los profesionales de la salud en la orientación y estímulo a la lactancia materna...