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Meta-Analysis
. 2020 Oct 9;10(10):CD006304.
doi: 10.1002/14651858.CD006304.pub4.

Local cooling for relieving pain from perineal trauma sustained during childbirth

Christine E East  1 , Emma Df Dorward  2 , Rhiannon E Whale  3 , Jiajia Liu  4
Affiliations
Meta-Analysis

Local cooling for relieving pain from perineal trauma sustained during childbirth

Christine E East et al. Cochrane Database Syst Rev. .

Abstract

Background: Perineal trauma is common during childbirth and may be painful. Contemporary maternity practice includes offering women numerous forms of pain relief, including the local application of cooling treatments. This Cochrane Review is an update of a review last updated in 2012.

Objectives: To evaluate the effectiveness of localised cooling treatments compared with no treatment, placebo, or other cooling treatments applied to the perineum for pain relief following perineal trauma sustained during childbirth.

Search methods: We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (7 October 2019) and reference lists of retrieved studies.

Selection criteria: Published and unpublished randomised and quasi-randomised trials (RCTs) that compared a localised cooling treatment applied to the perineum with no treatment, placebo, or another cooling treatment applied to relieve pain related to perineal trauma sustained during childbirth.

Data collection and analysis: Two review authors independently assessed study eligibility, extracted data and assessed the risk of bias of included studies. Data were double checked for accuracy. The certainty of the evidence was assessed using the GRADE approach.

Main results: We included 10 RCTs that enrolled 1233 women randomised to the use of one cooling treatment (ice, cold gel pad, cooling plus compression, cooling plus compression plus (being) horizontal) compared with another cooling treatment, no treatment, or placebo (water pack, compression). The included trials were at low or uncertain risk of bias overall, with the exception that the inability to blind participants and personnel to group allocation meant that we rated all trials at unclear or high risk for this domain. We undertook a number of comparisons to evaluate the different treatments. Cooling treatment (ice pack or cold gel pad) versus no treatment There was limited very low-certainty evidence that cooling treatment may reduce women's self-reported perineal pain within four to six hours (mean difference (MD) -4.46, 95% confidence interval (CI) -5.07 to -3.85 on a 10-point scale; 1 study, 100 participants) or between 24 and 48 hours of giving birth (risk ratio (RR) 0.73, 95% CI 0.57 to 0.94; 1 study, 316 participants). The evidence is very uncertain about the various measures of wound healing, for example, wound edges gaping when inspected five days after giving birth (RR 2.56, 95% CI 0.58 to 11.33; 1 study, 315 participants). Women generally rated their satisfaction with perineal care similarly following cooling or no treatment. The potential exception was that there may be a trivially lower mean difference of -0.1 on a five-point scale of psychospiritual comfort with cooling treatment, that is unlikely to be of clinical importance. Cooling treatment (cold gel pad) + compression versus placebo (gel pad + compression) There was limited low-certainty evidence that there may be a trivial MD of -0.43 in pain on a 10-point scale at 24 to 48 hours after giving birth (95% CI -0.73 to -0.13; 1 study, 250 participants) when a cooling treatment plus compression from a well-secured perineal pad was compared with the placebo. Levels of perineal oedema may be similar for the two groups (low-certainty evidence) and perineal bruising was not observed. There was low-certainty evidence that women may rate their satisfaction as being slightly higher with perineal care in the cold gel pad and compression group (MD 0.88, 95% CI 0.38 to 1.38; 1 trial, 250 participants). Cooling treatment (ice pack) versus placebo (water pack) One study reported that no women reported pain after using an ice pack or a water pack when asked within 24 hours of giving birth. There was low-certainty evidence that oedema may be similar for the two groups when assessed at four to six hours (RR 0.96, 95% CI 0.50 to 1.86; 1 study, 63 participants) or within 24 hours of giving birth (RR 0.36, 95% CI 0.08 to 1.59). No women were observed to have perineal bruising at these times. The trialists reported that no women in either group experienced any adverse effects on wound healing. There was very low-certainty evidence that women may rate their views and experiences with the treatments similarly (for example, satisfied with treatment: RR 0.91, 95% CI 0.77 to 1.08; 63 participants). Cooling treatment (ice pack) versus cooling treatment (cold gel pad) The evidence is very uncertain about the effects of using ice packs or cold gel pads on women's self-rated perineal pain, on perineal bruising, or on perineal oedema at four to six hours or within 24 hours of giving birth. Perineal oedema may persist 24 to 48 hours after giving birth in women using the ice packs (RR 1.69, 95% CI 1.03 to 2.7; 2 trials, 264 participants; very low-certainty). The risk of gaping wound edges five days after giving birth may be decreased in women who had used ice packs (RR 0.22, 95% CI 0.05 to 1.01; 215 participants; very low-certainty). However, this did not appear to persist to day 10 (RR 3.06, 95% CI 0.63 to 14.81; 214 participants). Women may rate their opinion of treatment less favourably following the use of ice packs five days after giving birth (RR 0.33, 95% CI 0.17 to 0.68; 1 study, 49 participants) and when assessed on day 10 (RR 0.82, 95% CI 0.73 to 0.92; 1 study, 208 participants), both very low-certainty.

Authors' conclusions: There is limited very low-certainty evidence that may support the use of cooling treatments, in the form or ice packs or cold gel pads, for the relief of perineal pain in the first two days following childbirth. It is likely that concurrent use of several treatments is required to adequately address this issue, including prescription and non-prescription analgesia. Studies included in this review involved the use of cooling treatments for 10 to 20 minutes, and although no adverse effects were noted, these findings came from studies of relatively small numbers of women, or were not reported at all. The continued lack of high-certainty evidence of the benefits of cooling treatments should be viewed with caution, and further well-designed trials should be conducted.

Trial registration: ClinicalTrials.gov NCT01626287 NCT02024256.

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Conflict of interest statement

Protocol and Review 2007; updated Review 2012 (East 2012)

Christine E East: received AUD 25,000 grant from the Queensland Nursing Council to support the 2007 protocol and review. Christine E East conducted an unpublished pilot study comparing the use of cold gel pads with ice packs in 2009. The study was not pursued due to lack of funding resources. It had not been considered for inclusion in the early versions of this review.

Lisa Begg: no interests to declare.

Paul R Marchant: collaborated in randomised controlled trials comparing the effectiveness of two cooling treatments for the relief of perineal pain following childbirth. These reports were included in the review (Steen 2000; Steen 2002) but were reviewed by other authors.

Karen Wallace: no interests to declare.

Updated review 2020

Christine E East: conducted an unpublished pilot study comparing the use of cold gel pads with ice packs in 2009. The study was not pursued due to lack of funding resources. It had been overlooked in previous versions of the review, given the pilot status.

Jiajia Liu: no interests to declare.

Emma Dorward: no interests to declare.

Rhiannon Whale: no interests to declare.

Figures

1
1
ReStudy flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1: Cooling treatment (ice pack or cold gel pad) versus no treatment, Outcome 1: Perineal pain within 4‐6 hours of giving birth
1.2
1.2. Analysis
Comparison 1: Cooling treatment (ice pack or cold gel pad) versus no treatment, Outcome 2: Perineal pain within 24 hours of giving birth
1.3
1.3. Analysis
Comparison 1: Cooling treatment (ice pack or cold gel pad) versus no treatment, Outcome 3: Perineal pain within 24 hours of giving birth
1.4
1.4. Analysis
Comparison 1: Cooling treatment (ice pack or cold gel pad) versus no treatment, Outcome 4: Perineal pain between 24 ‐ 48 hours after giving birth
1.5
1.5. Analysis
Comparison 1: Cooling treatment (ice pack or cold gel pad) versus no treatment, Outcome 5: Perineal pain between 24 ‐48 hours after giving birth
1.6
1.6. Analysis
Comparison 1: Cooling treatment (ice pack or cold gel pad) versus no treatment, Outcome 6: Pain associated with activities of daily living (sitting) within 24 hours of giving birth
1.7
1.7. Analysis
Comparison 1: Cooling treatment (ice pack or cold gel pad) versus no treatment, Outcome 7: Pain associated with activities of daily living (sitting) between 24 ‐ 48 hours of giving birth
1.8
1.8. Analysis
Comparison 1: Cooling treatment (ice pack or cold gel pad) versus no treatment, Outcome 8: Pain associated with activities of daily living (walking) within 24 hours of giving birth
1.9
1.9. Analysis
Comparison 1: Cooling treatment (ice pack or cold gel pad) versus no treatment, Outcome 9: Pain associated with activities of daily living (walking) between 24 ‐ 48 hours of giving birth
1.10
1.10. Analysis
Comparison 1: Cooling treatment (ice pack or cold gel pad) versus no treatment, Outcome 10: Pain associated with activities of daily living (feeding baby) within 24 hours of giving birth
1.11
1.11. Analysis
Comparison 1: Cooling treatment (ice pack or cold gel pad) versus no treatment, Outcome 11: Pain associated with activities of daily living (feeding baby) between 24 ‐ 48 hours of giving birth
1.12
1.12. Analysis
Comparison 1: Cooling treatment (ice pack or cold gel pad) versus no treatment, Outcome 12: Perineal oedema within 24 hours of giving birth
1.13
1.13. Analysis
Comparison 1: Cooling treatment (ice pack or cold gel pad) versus no treatment, Outcome 13: Perineal oedema between 24 ‐ 48 hours after giving birth
1.14
1.14. Analysis
Comparison 1: Cooling treatment (ice pack or cold gel pad) versus no treatment, Outcome 14: Perineal bruising within 24 hours of giving birth
1.15
1.15. Analysis
Comparison 1: Cooling treatment (ice pack or cold gel pad) versus no treatment, Outcome 15: Perineal bruising between 24 ‐ 48 hours after giving birth
1.16
1.16. Analysis
Comparison 1: Cooling treatment (ice pack or cold gel pad) versus no treatment, Outcome 16: Perineal redness, oedema, bruising, discharge, wound gaping within 24 hours of giving birth
1.17
1.17. Analysis
Comparison 1: Cooling treatment (ice pack or cold gel pad) versus no treatment, Outcome 17: Perineal redness, oedema, bruising, discharge, wound gaping between 24 ‐ 48 hours of giving birth
1.18
1.18. Analysis
Comparison 1: Cooling treatment (ice pack or cold gel pad) versus no treatment, Outcome 18: Additional analgesia for relief of perineal pain: within 24 hours of giving birth
1.19
1.19. Analysis
Comparison 1: Cooling treatment (ice pack or cold gel pad) versus no treatment, Outcome 19: Additional analgesia for relief of perineal pain between 24 ‐ 48 hours after giving birth
1.20
1.20. Analysis
Comparison 1: Cooling treatment (ice pack or cold gel pad) versus no treatment, Outcome 20: Adverse effects on perineal wound healing: Day 5
1.21
1.21. Analysis
Comparison 1: Cooling treatment (ice pack or cold gel pad) versus no treatment, Outcome 21: Adverse effects on perineal wound healing: Day 10
1.22
1.22. Analysis
Comparison 1: Cooling treatment (ice pack or cold gel pad) versus no treatment, Outcome 22: Maternal views and experiences of treatment
1.23
1.23. Analysis
Comparison 1: Cooling treatment (ice pack or cold gel pad) versus no treatment, Outcome 23: Maternal views and experiences of treatment
1.24
1.24. Analysis
Comparison 1: Cooling treatment (ice pack or cold gel pad) versus no treatment, Outcome 24: Women providing any breastmilk to baby 24 ‐ 48 hours after giving birth
1.25
1.25. Analysis
Comparison 1: Cooling treatment (ice pack or cold gel pad) versus no treatment, Outcome 25: Subgroup: Parity and perineal pain within 24 hours of giving birth
1.26
1.26. Analysis
Comparison 1: Cooling treatment (ice pack or cold gel pad) versus no treatment, Outcome 26: Subgroup: Parity and perineal pain between 24 ‐ 48 hours after giving birth
1.27
1.27. Analysis
Comparison 1: Cooling treatment (ice pack or cold gel pad) versus no treatment, Outcome 27: Subgroup: Mode of birth and perineal pain within 24 hours of giving birth
1.28
1.28. Analysis
Comparison 1: Cooling treatment (ice pack or cold gel pad) versus no treatment, Outcome 28: Subgroup: Mode of birth and perineal pain between 24 ‐ 48 hours after giving birth
2.1
2.1. Analysis
Comparison 2: Cooling treatment (cold gel pad)+compression versus placebo (gel pad+compression), Outcome 1: Perineal pain within 4 ‐ 6 hours of giving birth
2.2
2.2. Analysis
Comparison 2: Cooling treatment (cold gel pad)+compression versus placebo (gel pad+compression), Outcome 2: Perineal pain within 24 ‐ 48 hours after giving birth
2.3
2.3. Analysis
Comparison 2: Cooling treatment (cold gel pad)+compression versus placebo (gel pad+compression), Outcome 3: Perineal oedema between 24 ‐ 48 hours after giving birth
2.4
2.4. Analysis
Comparison 2: Cooling treatment (cold gel pad)+compression versus placebo (gel pad+compression), Outcome 4: Satisfaction with perineal care
3.1
3.1. Analysis
Comparison 3: Cooling treatment (ice pack) versus placebo (water pack), Outcome 1: Perineal oedema within 4 ‐ 6 hours after giving birth
3.2
3.2. Analysis
Comparison 3: Cooling treatment (ice pack) versus placebo (water pack), Outcome 2: Perineal oedema within 24 hours after giving birth
3.3
3.3. Analysis
Comparison 3: Cooling treatment (ice pack) versus placebo (water pack), Outcome 3: Additional analgesia for relief of perineal pain within 24 hours of giving birth
3.4
3.4. Analysis
Comparison 3: Cooling treatment (ice pack) versus placebo (water pack), Outcome 4: Maternal views and experiences with treatment
3.5
3.5. Analysis
Comparison 3: Cooling treatment (ice pack) versus placebo (water pack), Outcome 5: Women providing any breastmilk to baby 48 hours after giving birth
4.1
4.1. Analysis
Comparison 4: Cooling treatment (ice pack) versus cooling treatment (cold gel pad), Outcome 1: Perineal pain within 4 ‐ 6 hours of giving birth
4.2
4.2. Analysis
Comparison 4: Cooling treatment (ice pack) versus cooling treatment (cold gel pad), Outcome 2: Perineal pain within 24 hours of giving birth
4.3
4.3. Analysis
Comparison 4: Cooling treatment (ice pack) versus cooling treatment (cold gel pad), Outcome 3: Perineal pain within 24 hours of giving birth
4.4
4.4. Analysis
Comparison 4: Cooling treatment (ice pack) versus cooling treatment (cold gel pad), Outcome 4: Perineal pain between 24 ‐ 48 hours after giving birth
4.5
4.5. Analysis
Comparison 4: Cooling treatment (ice pack) versus cooling treatment (cold gel pad), Outcome 5: Perineal pain between 24 ‐ 48 hours of giving birth
4.6
4.6. Analysis
Comparison 4: Cooling treatment (ice pack) versus cooling treatment (cold gel pad), Outcome 6: Pain associated with activities of daily living (sitting) within 24 hours of giving birth
4.7
4.7. Analysis
Comparison 4: Cooling treatment (ice pack) versus cooling treatment (cold gel pad), Outcome 7: Pain associated with activities of daily living (sitting) between 24 ‐ 48 hours after giving birth
4.8
4.8. Analysis
Comparison 4: Cooling treatment (ice pack) versus cooling treatment (cold gel pad), Outcome 8: Pain associated with activities of daily living (walking) within 24 hours of giving birth
4.9
4.9. Analysis
Comparison 4: Cooling treatment (ice pack) versus cooling treatment (cold gel pad), Outcome 9: Pain associated with activities of daily living (walking) between 24 ‐ 48 hours after giving birth
4.10
4.10. Analysis
Comparison 4: Cooling treatment (ice pack) versus cooling treatment (cold gel pad), Outcome 10: Pain associated with activities of daily living (feeding baby) within 24 hours of giving birth
4.11
4.11. Analysis
Comparison 4: Cooling treatment (ice pack) versus cooling treatment (cold gel pad), Outcome 11: Pain associated with activities of daily living (feeding baby) between 24 ‐ 48 hours after giving birth
4.12
4.12. Analysis
Comparison 4: Cooling treatment (ice pack) versus cooling treatment (cold gel pad), Outcome 12: Perineal oedema within 4 ‐ 6 hours of giving birth
4.13
4.13. Analysis
Comparison 4: Cooling treatment (ice pack) versus cooling treatment (cold gel pad), Outcome 13: Perineal oedema within 24 hours of giving birth
4.14
4.14. Analysis
Comparison 4: Cooling treatment (ice pack) versus cooling treatment (cold gel pad), Outcome 14: Perineal oedema between 24 ‐ 48 hours after giving birth
4.15
4.15. Analysis
Comparison 4: Cooling treatment (ice pack) versus cooling treatment (cold gel pad), Outcome 15: Perineal bruising within 4 ‐ 6 hours of giving birth
4.16
4.16. Analysis
Comparison 4: Cooling treatment (ice pack) versus cooling treatment (cold gel pad), Outcome 16: Perineal bruising within 24 hours of giving birth
4.17
4.17. Analysis
Comparison 4: Cooling treatment (ice pack) versus cooling treatment (cold gel pad), Outcome 17: Perineal bruising between 24 ‐ 48 hours after giving birth
4.18
4.18. Analysis
Comparison 4: Cooling treatment (ice pack) versus cooling treatment (cold gel pad), Outcome 18: Perineal redness, oedema, bruising, discharge, wound gaping within 24 hours of giving birth
4.19
4.19. Analysis
Comparison 4: Cooling treatment (ice pack) versus cooling treatment (cold gel pad), Outcome 19: Perineal redness, oedema, bruising, discharge, wound gaping between 24 ‐ 48 hours after giving birth
4.20
4.20. Analysis
Comparison 4: Cooling treatment (ice pack) versus cooling treatment (cold gel pad), Outcome 20: Additional analgesia for relief of perineal pain: within 24 hours of giving birth
4.21
4.21. Analysis
Comparison 4: Cooling treatment (ice pack) versus cooling treatment (cold gel pad), Outcome 21: Additional analgesia for relief of perineal pain: 24 ‐ 48 hours after giving birth
4.22
4.22. Analysis
Comparison 4: Cooling treatment (ice pack) versus cooling treatment (cold gel pad), Outcome 22: Adverse effects on perineal wound healing: Day 5
4.23
4.23. Analysis
Comparison 4: Cooling treatment (ice pack) versus cooling treatment (cold gel pad), Outcome 23: Adverse effects on perineal wound healing: Day 10
4.24
4.24. Analysis
Comparison 4: Cooling treatment (ice pack) versus cooling treatment (cold gel pad), Outcome 24: Maternal views and experiences with treatment
4.25
4.25. Analysis
Comparison 4: Cooling treatment (ice pack) versus cooling treatment (cold gel pad), Outcome 25: Women providing any breastmilk to the baby 48 hours after giving birth
4.26
4.26. Analysis
Comparison 4: Cooling treatment (ice pack) versus cooling treatment (cold gel pad), Outcome 26: Subgroup: Parity and perineal pain within 24 hours of giving birth
4.27
4.27. Analysis
Comparison 4: Cooling treatment (ice pack) versus cooling treatment (cold gel pad), Outcome 27: Subgroup: Parity and perineal pain between 24 ‐ 48 hours after giving birth
4.28
4.28. Analysis
Comparison 4: Cooling treatment (ice pack) versus cooling treatment (cold gel pad), Outcome 28: Subgroup: Mode of birth and perineal pain within 24 hours of giving birth
4.29
4.29. Analysis
Comparison 4: Cooling treatment (ice pack) versus cooling treatment (cold gel pad), Outcome 29: Subgroup: Mode of birth and perineal pain between 24 ‐ 48 hours after giving birth
5.1
5.1. Analysis
Comparison 5: Cooling treatment (I.C.H. (ice, compression, (being) horizontal)) versus cooling treatment (ad hoc ice pack usage), Outcome 1: Perineal pain within 24 hours of giving birth
5.2
5.2. Analysis
Comparison 5: Cooling treatment (I.C.H. (ice, compression, (being) horizontal)) versus cooling treatment (ad hoc ice pack usage), Outcome 2: Perineal pain between 24 ‐ 48 hours after giving birth
5.3
5.3. Analysis
Comparison 5: Cooling treatment (I.C.H. (ice, compression, (being) horizontal)) versus cooling treatment (ad hoc ice pack usage), Outcome 3: Perineal pain associated with activities of daily living (sitting) within 24 hours of giving birth
5.4
5.4. Analysis
Comparison 5: Cooling treatment (I.C.H. (ice, compression, (being) horizontal)) versus cooling treatment (ad hoc ice pack usage), Outcome 4: Perineal pain associated with activities of daily living (sitting) between 24 ‐ 48 hours after giving birth
5.5
5.5. Analysis
Comparison 5: Cooling treatment (I.C.H. (ice, compression, (being) horizontal)) versus cooling treatment (ad hoc ice pack usage), Outcome 5: Perineal pain associated with activities of daily living (walking) within 24 hours of giving birth
5.6
5.6. Analysis
Comparison 5: Cooling treatment (I.C.H. (ice, compression, (being) horizontal)) versus cooling treatment (ad hoc ice pack usage), Outcome 6: Perineal pain associated with activities of daily living (walking) between 24 ‐ 48 hours after giving birth
5.7
5.7. Analysis
Comparison 5: Cooling treatment (I.C.H. (ice, compression, (being) horizontal)) versus cooling treatment (ad hoc ice pack usage), Outcome 7: Perineal pain associated with activities of daily living (urinating) within 24 hours of giving birth
5.8
5.8. Analysis
Comparison 5: Cooling treatment (I.C.H. (ice, compression, (being) horizontal)) versus cooling treatment (ad hoc ice pack usage), Outcome 8: Perineal pain associated with activities of daily living (urinating) between 24 ‐ 48 hours after giving birth
5.9
5.9. Analysis
Comparison 5: Cooling treatment (I.C.H. (ice, compression, (being) horizontal)) versus cooling treatment (ad hoc ice pack usage), Outcome 9: Perineal pain associated with activities of daily living (caring for baby) within 24 hours of giving birth
5.10
5.10. Analysis
Comparison 5: Cooling treatment (I.C.H. (ice, compression, (being) horizontal)) versus cooling treatment (ad hoc ice pack usage), Outcome 10: Perineal pain associated with activities of daily living (caring for baby) between 24 ‐ 48 hours after giving birth
5.11
5.11. Analysis
Comparison 5: Cooling treatment (I.C.H. (ice, compression, (being) horizontal)) versus cooling treatment (ad hoc ice pack usage), Outcome 11: Additional analgesia for relief of perineal pain: within 24 hours of giving birth
5.12
5.12. Analysis
Comparison 5: Cooling treatment (I.C.H. (ice, compression, (being) horizontal)) versus cooling treatment (ad hoc ice pack usage), Outcome 12: Additional analgesia for relief of perineal pain: between 24 ‐ 48 hours after giving birth
5.13
5.13. Analysis
Comparison 5: Cooling treatment (I.C.H. (ice, compression, (being) horizontal)) versus cooling treatment (ad hoc ice pack usage), Outcome 13: Self‐reported energy level: within 24 hours of giving birth
5.14
5.14. Analysis
Comparison 5: Cooling treatment (I.C.H. (ice, compression, (being) horizontal)) versus cooling treatment (ad hoc ice pack usage), Outcome 14: Self‐reported energy level: between 24 ‐ 48 hours of giving birth
5.15
5.15. Analysis
Comparison 5: Cooling treatment (I.C.H. (ice, compression, (being) horizontal)) versus cooling treatment (ad hoc ice pack usage), Outcome 15: Maternal views of effectiveness of ice packs: within 24 hours of giving birth
5.16
5.16. Analysis
Comparison 5: Cooling treatment (I.C.H. (ice, compression, (being) horizontal)) versus cooling treatment (ad hoc ice pack usage), Outcome 16: Maternal views of effectiveness of ice packs: between 24 ‐ 48 hours of giving birth
5.17
5.17. Analysis
Comparison 5: Cooling treatment (I.C.H. (ice, compression, (being) horizontal)) versus cooling treatment (ad hoc ice pack usage), Outcome 17: Women providing any breastmilk to the baby between 24 ‐ 48 hours after giving birth
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References

References to studies included in this review

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Steen 2000 {published data only}
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References to studies excluded from this review

Amani 2015 {published data only}
    1. Amani R, Kariman N, Mojab F, Alavi H, Majidi S. Comparison of the effects of cold compress with gel packs and topical olive oil on episiotomy wound healing. Journal of Babol University of Medical Sciences 2015;17(11):7-12.
    1. IRCT201409164529N12. Comparison the effect of cooling gel pads and topical olive oil on the intensity of episiotomy pain and wound healing in primiparous women referring to hospitals affiliated with the Gilan university of Medical Sciences in 2014. irct.ir/trial/4833 (first received 30 October 2014).
De Souza Bosco Paiva 2016 {published data only}
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Dube 2013 {published data only}
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    1. NCT02024256. Comparison between treatment with gauze soaked with cold magnesium sulfate solution against gauze soaked with cold water for treatment of perineal swelling following vaginal delivery - a double blind placebo controlled trial. clinicaltrials.gov/ct2/show/NCT02024256 (first received 31 December 2013).
Pinkerton 1961 {published data only}
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Ramler 1986 {published data only}
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Sheikhan 2011 {published data only}
    1. IRCT138807192248N3. The effect of cold therapy and the essential lavender oil on pain intensity and healing of episiotomy among primiparous women. irct.ir/trial/1878 (first received 26 April 2010).
    1. Sheiken F, Jahdi F, Khoie EM, Alizadeh NS, Sheikhan H, Haghani H. Episiotomy discomforts relief using cold gel pads in primiparous Iranian women (A comparative study). Research Journal of Medical Sciences 2011;5(3):150-4.
Thangaraju 2006 {published data only}
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References to studies awaiting assessment

Leventhal 2011 {published data only}
    1. ACTRN12608000439347. Ice pack for relieving perineal pain after normal delivery. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12608000439347 (first received 3 September 2008).
    1. Leventhal LC, De Oliveira SM, Nobre MR, Da Silva FM. Perineal analgesia with an ice pack after spontaneous vaginal birth: a randomized controlled trial. Journal of Midwifery and Women's Health 2011;56(2):141-6. - PubMed
Oliveira 2012 {published data only}
    1. ACTRN12608000551392. Comparing three duration times of cryotherapy (10, 15 and 20 minutes) in pregnant women for relieving pain from perineal trauma after birth. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12608000551392 (first received 5 September 2008).
    1. Oliveira SM, Silva FM, Riesco ML, Latorre M do R, Nobre MR. Comparison of application times for ice packs used to relieve perineal pain after normal birth: a randomised clinical trial. Journal of Clinical Nursing 2012;21(23-24):3382-91. - PubMed

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References to other published versions of this review

East 2007
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Publication types

Associated data