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Meta-Analysis
. 2013 Jul 22;2013(7):CD000330.
doi: 10.1002/14651858.CD000330.pub4.

Enemas during labour

Ludovic Reveiz  1 , Hernando G Gaitán, Luis Gabriel Cuervo
Affiliations
Meta-Analysis

Enemas during labour

Ludovic Reveiz et al. Cochrane Database Syst Rev. .

Abstract

Background: Although the use of enemas during labour usually reflects the preference of the attending healthcare provider, enemas may cause discomfort for women.

Objectives: To assess the effects of enemas applied during the first stage of labour on maternal and neonatal outcomes.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2013), the Cochrane Central Register of Controlled Trials and Database of Abstracts of Reviews of Effectiveness (The Cochrane Library 2013, Issue 5), PubMed (1966 to 31 May 2013), LILACS (31 May 2013), the Search Portal of the International Clinical Trials Registry Platform (ICTRP) (31 May 2013), Health Technology Assessment Program, UK (31 May 2013), Medical Research Council, UK (31 May 2013), The Wellcome Trust, UK (31 May 2013) and reference lists of retrieved articles.

Selection criteria: Randomised controlled trials (RCTs) in which an enema was administered during the first stage of labour and which included assessment of possible neonatal or puerperal morbidity or mortality.

Data collection and analysis: Two review authors independently assessed studies for inclusion.

Main results: Four RCTs (1917 women) met the inclusion criteria. One study was judged as having a low risk of bias. In the meta-analysis we conducted of two trials, we found no significant difference in infection rates for puerperal women (two RCTs; 594 women; risk ratio (RR) 0.66, 95% confidence (CI) 0.42 to 1.04). No significant differences were found in neonatal umbilical infection rates (two RCTs; 592 women; RR 3.16, 95% CI 0.50 to 19.82; I(2) 0%. In addition, meta-analysis of two studies found that there were no significant differences in the degree of perineal tear between groups. Finally, meta-analysis of two trials found no significant differences in the mean duration of labour.

Authors' conclusions: The evidence provided by the four included RCTs shows that enemas do not have a significant beneficial effect on infection rates such as perineal wound infection or other neonatal infections and women's satisfaction. These findings speak against the routine use of enemas during labour, therefore, such practice should be discouraged.

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Conflict of interest statement

Dr Luis Gabriel Cuervo conducted a randomised controlled trial included in this review. His study fulfilled the inclusion criteria for this review. For this review, he was not involved in the selection of studies or in the appraisal of his study. Information from this study was independently collected and appraised by the other review authors.

Figures

1
1
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Enema versus no enema, Outcome 1 Episiotomy dehiscence.
1.2
1.2. Analysis
Comparison 1 Enema versus no enema, Outcome 2 Neonatal infection (all infections, including umbilical).
1.3
1.3. Analysis
Comparison 1 Enema versus no enema, Outcome 3 Neonatal infection (not specified) at 4 days.
1.4
1.4. Analysis
Comparison 1 Enema versus no enema, Outcome 4 Neonatal Infection (any infectious outcome, during the first month of life).
1.5
1.5. Analysis
Comparison 1 Enema versus no enema, Outcome 5 Neonatal infection: umbilical infection.
1.6
1.6. Analysis
Comparison 1 Enema versus no enema, Outcome 6 Neonatal infection: respiratory tract infection (high ‐ during first month).
1.7
1.7. Analysis
Comparison 1 Enema versus no enema, Outcome 7 Neonatal infection: respiratory tract infection (low ‐ during first month).
1.8
1.8. Analysis
Comparison 1 Enema versus no enema, Outcome 8 Neonatal infection: meningitis.
1.9
1.9. Analysis
Comparison 1 Enema versus no enema, Outcome 9 Neontal infection: sepsis.
1.10
1.10. Analysis
Comparison 1 Enema versus no enema, Outcome 10 Perineal tear: skin or superficial tissue without compromising muscle.
1.11
1.11. Analysis
Comparison 1 Enema versus no enema, Outcome 11 Perineal tear: perineal muscle without anal muscles.
1.12
1.12. Analysis
Comparison 1 Enema versus no enema, Outcome 12 Perineal tear: compromises anal muscles but not the mucosa.
1.13
1.13. Analysis
Comparison 1 Enema versus no enema, Outcome 13 Perineal tear: complete tear that compromises anal mucosa.
1.14
1.14. Analysis
Comparison 1 Enema versus no enema, Outcome 14 No episiotomy wound ‐ no further tear.
1.15
1.15. Analysis
Comparison 1 Enema versus no enema, Outcome 15 No episiotomy wound ‐ further tear: 1st degree tear.
1.16
1.16. Analysis
Comparison 1 Enema versus no enema, Outcome 16 Episiotomy wound ‐ no further tear.
1.17
1.17. Analysis
Comparison 1 Enema versus no enema, Outcome 17 Episiotomy wound ‐ further tear: 3rd degree tear.
1.18
1.18. Analysis
Comparison 1 Enema versus no enema, Outcome 18 One‐minute Apgar < 7.
1.19
1.19. Analysis
Comparison 1 Enema versus no enema, Outcome 19 Five‐minute Apgar < 7.
1.20
1.20. Analysis
Comparison 1 Enema versus no enema, Outcome 20 Faecal soiling during delivery.
1.21
1.21. Analysis
Comparison 1 Enema versus no enema, Outcome 21 Duration of labour (minutes).
1.22
1.22. Analysis
Comparison 1 Enema versus no enema, Outcome 22 Duration of labour (second stage).
1.23
1.23. Analysis
Comparison 1 Enema versus no enema, Outcome 23 Parturients' levels of satisfaction (Likert scale).
1.24
1.24. Analysis
Comparison 1 Enema versus no enema, Outcome 24 Labour attendants' levels of satisfaction (Likert scale).
1.25
1.25. Analysis
Comparison 1 Enema versus no enema, Outcome 25 Accoucheurs' levels of satisfaction (Likert scale).
1.26
1.26. Analysis
Comparison 1 Enema versus no enema, Outcome 26 Perineorrhaphy operators' levels of satisfaction (Likert scale).
1.27
1.27. Analysis
Comparison 1 Enema versus no enema, Outcome 27 Pelvic infection: infected episiotomy.
1.28
1.28. Analysis
Comparison 1 Enema versus no enema, Outcome 28 Pelvic infection: vulvovaginitis.
1.29
1.29. Analysis
Comparison 1 Enema versus no enema, Outcome 29 Pelvic infection: endometritis.
1.30
1.30. Analysis
Comparison 1 Enema versus no enema, Outcome 30 Pelvic infection: myometritis.
1.31
1.31. Analysis
Comparison 1 Enema versus no enema, Outcome 31 Urinary tract infection.
1.32
1.32. Analysis
Comparison 1 Enema versus no enema, Outcome 32 Other puerperal Infections.
1.33
1.33. Analysis
Comparison 1 Enema versus no enema, Outcome 33 Other puerperal infections: Intrapartum infection rates.
1.34
1.34. Analysis
Comparison 1 Enema versus no enema, Outcome 34 Need for systemic antibiotics (postpartum).
1.35
1.35. Analysis
Comparison 1 Enema versus no enema, Outcome 35 Need for systemic antibiotics (neonatal ‐ after hospital discharge during the first month).
1.36
1.36. Analysis
Comparison 1 Enema versus no enema, Outcome 36 Opthalmic infection (dacriocistitis or conjunctivitis in first month).
1.37
1.37. Analysis
Comparison 1 Enema versus no enema, Outcome 37 Skin infection (first month).
1.38
1.38. Analysis
Comparison 1 Enema versus no enema, Outcome 38 Intestinal infection.
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References

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