The effects of warm perineal compress on perineal trauma and postpartum pain: a systematic review with meta-analysis and trial sequential analysis.

BACKGROUND: In order to reduce the complications of perineal damage and the pain caused by it for the mother, this study was conducted to determine the effect of warm perineal compress on perineal trauma (1st-, 2nd-, 3rd-, and 4th-degree perineal tears), postpartum pain, intact perineum (primary outcomes), episiotomy, length of the second stage, and APGAR score at 1 and 5 min after childbirth (secondary outcome). METHODS: PubMed, Scopus, Cochrane Central Register of Controlled Trials, Google Scholar, Web of Science, SID, Magiran, and ClinicalTrials.gov were searched to identify the relevant articles from inception to November 1, 2022, with language restriction (only English and Persian). A manual search was also performed. Risk of bias 2 (RoB2) and ROBIN-I were employed to evaluate the quality of the included papers. Meta-analysis was conducted using RevMan 5.3. Heterogeneity was assessed using I2. In cases with high heterogeneity, subgroup analysis was utilized based on the parity and ethnicity, and time of pain measurement after delivery also a random-effects model was used instead of a fixed-effects model. Trial sequential analysis (TSA) was performed for the primary outcomes. The certainty of evidence was assessed using the GRADE approach. RESULTS: A total number of 228 articles were found in databases. Of these articles, eighty-six were screened by title, 27 by abstract, and 21 by full text. Finally, 14 articles were included, of which ten were RCT and four were non-RCT. Meta-analysis results revealed that warm perineal compress significantly reduced perineal pain (RR 0.23, 95% CI 0.08-0.66; P = 0.0006), average pain (SMD - 0.73, 95% CI 1.23 to - 0.23; P = 0.004), second-degree perineal tear (RR 0.65, 95% CI 0.54-0.79; P˂0.00001), third-degree perineal tear (RR 0.32, 95% CI 0.15-0.67; P = 0.003), fourth-degree perineal tear (RR 0.11, 95% CI 0.01-0.87; P = 0.04), episiotomy (RR 0.63, 95% CI 0.46-0.86; P = 0.004), and intact perineum significantly increased (RR 3.06, 95% CI 1.79-5.22; P < 0.0001) compared to the control group. However, there was no statistically significant difference in terms of first-degree tear (RR 1.04, 95% CI 0.86-1.25; P = 0.72), length of the second stage of labor (MD - 0.60, 95% CI - 2.43 to 1.22; P = 0.52), the first minute (MD - 0.03, 95% CI - 0.07 to 0.02; P = 0.24) and the fifth minute Apgar score (MD - 0.02, 95% CI - 0.07 to 0.03; P = 0.46) between the two groups. CONCLUSION: Warm perineal compress administered during the second stage of labor reduce postpartum pain, second and third-degree perineal tears, and episiotomy rate while it increases the incidence of intact perineum compared to the control group.

Comparing the Efficacy of Breast Milk and Coconut Oil on Nipple Fissure and Breast Pain Intensity in Primiparous Mothers: A Single-Blind Clinical Trial.

Background: Nipple fissure is a prevalent problem for breastfeeding mothers. Virgin coconut oil (VCO) is an herbal medicine that can heal microbial infections and wounds. Objective: This study aims to evaluate the efficacy of VCO and breast milk on nipple fissures in primiparous mothers. Design, Setting, Participants, and Intervention: A single-blind clinical trial was conducted with 106 breastfeeding primiparous mothers suffering from nipple fissures in health centers of Zarand, Kerman, from August 2020 to November 2020. The participants were selected randomly and allocated to two 60-member groups using block randomization. Mothers in the first group were asked to apply 0.5 mL of coconut oil on their nipples three times a day. Mothers in the second group were trained to apply three to four drops of their milk on their nipples after every breastfeeding session. The level of nipple fissures and pain intensity were examined using Storr's scale and visual analog scale, respectively. The results were analyzed using the chi-square test, repeated measures analysis of variance, and the independent samples t-test in SPSS 22. In this study, the significance level was set at p < 0.05. Results: Within-group comparisons revealed a significant difference between baseline scores and the scores on the 7th and 14th days (p < 0.001). Between-group comparison indicated no significant difference in nipple fissure (p = 0.419) and pain intensity (p = 0.405) at baseline. Nonetheless, there was a significant difference on the 7th day (pfissure = 0.002, ppain <0.001) and on the 14th day (pfissure <0.001, ppain = 0.036). Conclusion: Given its effect on nipple fissures, VCO may be used as a complementary substance to treat nipple fissures. Trial Registration: This trial is registered with the Iranian Registry of Clinical Trials with the identifier: IRCT20190724044318N1.

The effects of vitamin E on the intensity of primary dysmenorrhea: A systematic review and meta-analysis.

BACKGROUND & AIMS: Primary dysmenorrhea (PD) refers to the presence of painful menstrual cramps due to increased synthesis of prostaglandins. Vitamin E inhibits the release of arachidonic acid and its conversion to prostaglandins through its antioxidant properties. This study sought to examine the effects of oral vitamin E supplementation on PD intensity (primary outcome) and its side effects (secondary outcomes). METHODS: In this systematic review and meta-analysis, databases in English and Persian, including PubMed, Cochrane Library, Google Scholar, Scopus, Web of Science, SID, and Magiran, were systematically searched until August 30, 2021. The study included all randomized, controlled clinical trials comparing oral vitamin E to placebo in healthy women with PD and measuring PD severity as a primary or secondary outcome. The quality of the included articles was assessed using the Cochrane Handbook, and the meta-analysis was performed using RevMan software. Given the continuous nature of the data and the utilization of different tools in the extracted articles, the meta-analysis results were reported using standardized mean difference (SDM) and 95% confidence interval (95% CI). A subgroup analysis was performed in low-dose (100 units), moderate-dose (200 units), and high-dose (400 units) categories. The quality of evidence was examined according to the GRADE approach. RESULTS: Eight articles with a sample size of 1002 people were entered into this systematic review. The results of meta-analysis revealed that vitamin E consumption significantly reduced PD mean intensity in the first month (n = 7 records; SDM = -1.16; 95%CI: -2.16 to -0.17; I2 = 31.9%; P = 0.02) and the second month (n = 8 records; SDM = -1.83; 95%CI: -2.90 to -0.77; I2 = 76.3.9%; P < 0.0001) compared with placebo. Serious side effects were not reported in vitamin E recipients. CONCLUSION: Vitamin E could be an adjunctive treatment for women with PD. However, higher-quality clinical trials with larger sample sizes are recommended for a more definite conclusion. PROSPERO ID: CRD42021276609.

Effect of vitamin D supplementation on the severity of stress urinary incontinence in premenopausal women with vitamin D insufficiency: a randomized controlled clinical trial.

BACKGROUND: Urinary incontinence, especially stress urinary incontinence (SUI), is one of the problems experienced by premenopausal women. Given the role of vitamin D in enhancing muscle strength and function, this study explored the effect of vitamin D3 supplementation on SUI in premenopausal women. METHODS: A randomized controlled trial was performed with 60 premenopausal women referring to Kerman gynecological clinic in 2020 and 2021. Eligible women received a 5000-unit vitamin D supplement or placebo weekly for 3 months. The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-SF) was utilized to assess SUI severity before and after the intervention. The t-test, Chi-square test, and repeated measures ANOVA were carried out in SPSS software (version 22) to analyze the data. P-values smaller than 0.05 were considered significant. RESULTS: Before the intervention, there was no significant difference between the intervention and control groups in SUI severity (P = 0.652) and the impact of SUI severity on premenopausal women's lives (P = 0.804). In contrast, after 8-12 weeks of vitamin D supplementation, these scores decreased significantly in the intervention group relative to the control group (P <  0.001). In addition, after vitamin D supplementation, the number of SUI and urinary leakage symptoms decreased in the intervention group (P <  0.001). CONCLUSION: Vitamin D supplementation improves SUI in premenopausal women. TRIAL REGISTRATION: This trial was registered with the Iranian Registry of Clinical Trials; https://fa.irct.ir/trial/53474 (IRCT20190724044318N2) on 11/02/2021.

The Association Between Demographic Characteristics and Attempting of Pregnancy with Postpartum Depression and Anxiety Among Women Referring to Community Health Centres: A Cross Sectional Study.

BACKGROUND: Postpartum depression (PPD) and anxiety are considered as a risk factor for mother and infant health. Therefore, the present study aims to explore the association between demographic characteristics and pregnancies with PPD and anxiety. METHODS: A cross-sectional study was conducted on 400 Iranian women referring to health centres of the Zarand City four weeks to six months from the date of their childbirth, in the first half of 2018. RESULT: The results showed that employed women with pregnancies who were categorised as depression and anxiety were more likely to have low gestational age, food insecurity, several deliveries, cesarean delivery and unintended pregnancy as well as they were not satisfied with their infant's gender. Also, women with several deliveries had lower risk for PPD before and after adjustment for confounders (odds ratio [OR] = 0.92, 95% confidence interval [CI]: 0.88-0.97, P < 0.001) and had lower risk for postpartum anxiety only after adjustment for confounders (OR = 0.82, 95% CI: 0.75-0.89, P < 0.001). CONCLUSION: Eventually, demographic characteristics and attempting of pregnancy were independently associated with PPD and postpartum anxiety in women. There need to be more social and governmental support of employed women after delivery to decrease their occupational stresses to deal with PPD and anxiety in the studied population.