Cochrane · systematic review · CD004908
Relief of pain due to uterine cramping/involution after birth
Deussen, AR, Ashwood, P, Martis, R, et al. · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
Pregnancy and ChildbirthAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
49
current version
GRADE rated
18
No studies
30
Included studies
NR
No studies 30 · 61.2%Ungraded 1 · 2%Very low 9 · 18.4%Low 7 · 14.3%Moderate 2 · 4.1%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
NSAID compared to placebo for relief of pain due to uterine cramping/involution after birth
Population: women who have given birth vaginally, requiring analgesia for after‐birth pains.
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adequate pain relief as reported by the woman (5 to 8 hours) NSAID vs placebo | RR 1.66 [1.45, 1.91] | 11 studies · 946 participants | Moderate Downgraded: risk of bias |
Need for additional pain relief (5 to 8 hours) NSAID vs placebo | RR 0.15 [0.07, 0.33] | 4 studies · 375 participants | Low Downgraded: risk of bias, imprecision |
Maternal adverse events (4 to 8 hours) NSAID vs placebo | RR 1.05 [0.78, 1.41] | 9 studies · 598 participants | Low Downgraded: risk of bias, imprecision |
Neonatal adverse events NSAID vs placebo | no estimate extracted | NR | No studies |
Duration of hospital stay NSAID vs placebo | no estimate extracted | NR | No studies |
Any breastfeeding at hospital discharge NSAID vs placebo | no estimate extracted | NR | No studies |
Any breastfeeding at 6 weeks postpartum NSAID vs placebo | no estimate extracted | NR | No studies |
NSAID compared to opioid for relief of pain due to uterine cramping/involution after birth
Population: women who have given birth vaginally, requiring analgesia for after‐birth pains.
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adequate pain relief as reported by the woman (5 to 8 hours) NSAID vs opioid | RR 1.33 [1.13, 1.57] | 5 studies · 560 participants | Moderate Downgraded: risk of bias |
Need for additional pain relief (6 to 8 hours) NSAID vs opioid | RR 0.37 [0.12, 1.12] | 2 studies · 232 participants | Low Downgraded: risk of bias, imprecision |
Maternal adverse events (6 to 8 hours) NSAID vs opioid | RR 0.62 [0.43, 0.89] | 3 studies · 255 participants | Low Downgraded: risk of bias, imprecision |
Neonatal adverse events NSAID vs opioid | no estimate extracted | NR | No studies |
Duration of hospital stay NSAID vs opioid | no estimate extracted | NR | No studies |
Any breastfeeding at hospital discharge NSAID vs opioid | no estimate extracted | NR | No studies |
Any breastfeeding at 6 weeks postpartum NSAID vs opioid | no estimate extracted | NR | No studies |
Opioid compared to placebo for relief of pain due to uterine cramping/involution after birth
Population: women who have given birth vaginally, requiring analgesia for after‐birth pains.
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adequate pain relief as reported by the woman (5 to 8 hours) Opioid vs placebo | RR 1.26 [0.99, 1.61] | 5 studies · 299 participants | Low Downgraded: risk of bias, imprecision |
Need for additional pain relief (6 to 8 hours) Opioid vs placebo | RR 0.48 [0.28, 0.82] | 3 studies · 273 participants | Low Downgraded: risk of bias, imprecision |
Maternal adverse events (6 to 8 hours) Opioid vs placebo | RR 1.59 [0.99, 2.55] | 3 studies · 188 participants | Low Downgraded: risk of bias, imprecision |
Neonatal adverse events Opioid vs placebo | no estimate extracted | NR | No studies |
Duration of hospital stay Opioid vs placebo | no estimate extracted | NR | No studies |
Any breastfeeding at hospital discharge Opioid vs placebo | no estimate extracted | NR | No studies |
Any breastfeeding at 6 weeks postpartum Opioid vs placebo | no estimate extracted | NR | No studies |
Paracetamol compared to placebo for relief of pain due to uterine cramping/involution after birth
Population: women who have given birth vaginally, requiring analgesia for after‐birth pains.
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adequate pain relief as reported by the woman (6 hours) Paracetamol vs placebo | RR 1.27 [0.8, 2] | 1 study · 48 participants | Very low Downgraded: risk of bias, imprecision |
Need for additional pain relief (up to 4 hours) Paracetamol vs placebo | RR 0.74 [0.21, 2.54] | 1 study · 75 participants | Very low Downgraded: risk of bias, imprecision |
Maternal adverse events (up to 4 hours and at 6 hours) Paracetamol vs placebo | RR 2.27 [0.97, 5.33] | 2 studies · 123 participants | Very low Downgraded: risk of bias, imprecision |
Neonatal adverse events Paracetamol vs placebo | no estimate extracted | NR | No studies |
Duration of hospital stay Paracetamol vs placebo | no estimate extracted | NR | No studies |
Any breastfeeding at hospital discharge Paracetamol vs placebo | no estimate extracted | NR | No studies |
Any breastfeeding at 6 weeks postpartum Paracetamol vs placebo | no estimate extracted | NR | No studies |
Paracetamol compared to NSAID for relief of pain due to uterine cramping/involution after birth
Population: women who have given birth vaginally, requiring analgesia for after‐birth pains.
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adequate pain relief as reported by the woman (6 hours) Paracetamol vs NSAID | RR 0.89 [0.62, 1.26] | 1 study · 48 participants | Very low Downgraded: risk of bias, imprecision |
Need for additional pain relief Paracetamol vs NSAID | no estimate extracted | NR | No studies |
Maternal adverse events (up to 4 hours and at 6 hours) Paracetamol vs NSAID | RR 0.99 [0.52, 1.86] | 2 studies · 112 participants | Very low Downgraded: risk of bias, imprecision |
Neonatal adverse events Paracetamol vs NSAID | no estimate extracted | NR | No studies |
Duration of hospital stay Paracetamol vs NSAID | no estimate extracted | NR | No studies |
Any breastfeeding at hospital discharge Paracetamol vs NSAID | no estimate extracted | NR | No studies |
Any breastfeeding at 6 weeks postpartum Paracetamol vs NSAID | no estimate extracted | NR | No studies |
NSAID compared to herbal analgesia for relief of pain due to uterine cramping/involution after birth
Population: women who have given birth vaginally, requiring analgesia for after‐birth pains.
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adequate pain relief as reported by the woman (1 to 4 hours) NSAID vs herbal analgesia | RR 0.96 [0.78, 1.18] | 4 studies · 394 participants | Very low Downgraded: risk of bias, indirectness |
Need for additional pain relief (4 hours) NSAID vs herbal analgesia | RR 1 [0.44, 2.29] | 1 study · 90 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Maternal adverse events (1 hour) NSAID vs herbal analgesia | RR 5 [0.6, 41.39] | 1 study · 108 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Neonatal adverse events NSAID vs herbal analgesia | no estimate extracted | NR | No studies |
Duration of hospital stay NSAID vs herbal analgesia | no estimate extracted | NR | No studies |
Any breastfeeding at hospital discharge NSAID vs herbal analgesia | no estimate extracted | NR | No studies |
Any breastfeeding at 6 weeks postpartum NSAID vs herbal analgesia | no estimate extracted | NR | No studies |
TENS compared to no TENS for relief of pain due to uterine cramping/involution after birth
Population: women who have given birth vaginally, requiring analgesia for after‐birth pains.
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adequate pain relief as reported by the woman (during next breast feed) TENS vs no TENS | RR 4 [0.5, 31.98] | 1 study · 32 participants | Very low Downgraded: risk of bias, imprecision |
Need for additional pain relief TENS vs no TENS | no estimate extracted | NR | No studies |
Maternal adverse events TENS vs no TENS | no estimate extracted | 32 participants | Ungraded |
Neonatal adverse events TENS vs no TENS | no estimate extracted | NR | No studies |
Duration of hospital stay TENS vs no TENS | no estimate extracted | NR | No studies |
Any breastfeeding at hospital discharge TENS vs no TENS | no estimate extracted | NR | No studies |
Any breastfeeding at 6 weeks postpartum TENS vs no TENS | no estimate extracted | NR | No studies |