Analgesics for pain relief from uterine cramping/involution following vaginal birth

January 01, 0001

Analgesics for pain relief from uterine cramping/involution following vaginal birth

Clinical Question: Which are the most effective analgesics for pain relief from uterine cramping/involution following vaginal birth?

Bottom line: Non-steroidal anti-inflammatory drugs (NSAIDs) including aspirin were better than placebo in relieving pain following vaginal birth. NSAIDs were better than paracetamol, and paracetamol was not better than placebo, though numbers of participants for these comparisons were small. Data for opioids compared with NSAIDs and opioids compared with placebo were conflicting, with some measures showing similar effect and others indicating NSAIDs were better than opioids and opioids were not better than placebo. There was insufficient evidence to make any recommendations for clinical practice.

Caveat: Only 9 of the included studies (with 750 women) reporting 24 comparisons of analgesia with other analgesia or placebo had data that could be included in the meta-analyses. The majority of analyses in this review included only 1 study with small numbers of participants. The average year of the included studies was 1981.

Context: Women may experience cramping pain and discomfort follow.ing the birth of their baby as the uterus contracts and returns to its pre-pregnancy size. These after-birth pains are caused by involutionary contractions and usually last for 2 to 3 days after childbirth. They are more evident for women who have previously had a baby. Breastfeeding stimulates the uterus to contract and increases the severity of after-birth pains.

Cochrane Systematic Review: Deussen AR, Ashwood P, Martis R. Analgesia for relief of pain due to uterine cramping/involution after birth. Cochrane Reviews, 2011, Issue 5. Article No. CD004908. DOI: 10.1002/14651858. CD004908.pub2. This review contains 18 studies involving 1498 participants.

Cochrane PEARLS Practical Evidence About Real Life Situations. No. 324, August 2011.
Written by Brian R McAvoy. Published by the Cochrane Primary Care Group

Category: W. Pregnancy, Family Planning. Keywords: post partum, pain, cramping, analgesia, nonsteroidal anti-inflammatories, NSAIDS
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 4 November 2011

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Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.