H Christensen, A S Henderson
Is age kinder to the initially more able? A study of eminent scientists and academics
Psychological medicine
perineal pain common poorly studied adverse outcome following childbirth pain may result perineal trauma due bruising spontaneous tears surgical incisions episiotomies association operative vaginal births ventouse forcepsassisted births update review last published 2013 determine efficacy single administration paracetamol acetaminophen used relief acute postpartum perineal pain update searched cochrane pregnancy childbirths trials register clinicaltrialsgov international clinical trials registry platform 9 december 2019 reference lists retrieved studies randomised controlled trials rcts including clusterrcts comparing paracetamol placebo excluded quasircts crossover trials data abstracts would included authors confirmed writing data included review come final analysis would change two review authors assessed study inclusion extracted data one review author reviewed decisions confirmed calculations pain relief scores assessed certainty evidence using grade approach update identified new trials results remain unchanged however applying grade assessment evidence interpretation main results differed previous version review identified 10 studies involving 2044 women studies involved either three four groups looking differing drugs doses included 1301 women paracetamol versus placebo arms studies five studies 482 women assessed 500 mg 650 mg six studies 797 women assessed 1000 mg paracetamol one study assessed 650 mg 1000 mg compared placebo contributed comparisons used randomeffects metaanalysis clinical variability among studies studies 1970s early 1990s insufficient information assess risk bias adequately hence findings need interpreted within context certainty evidence two primary outcomes data available assessed low downgraded overall unclear risk bias heterogeneity statistic 60 greater women may experience pain relief paracetamol compared placebo average risk ratio rr 214 95 confidence interval ci 159 289 10 trials 1279 women fewer women may need additional pain relief paracetamol compared placebo average rr 034 95 ci 021 055 8 trials 1132 women however certainty evidence low downgraded unclear overall risk bias substantial heterogeneity one study used higher dose paracetamol 1000 mg reported maternal drug adverse effects may little difference incidence nausea average rr 018 95 ci 001 366 1 trial 232 women lowcertainty evidence sleepiness average rr 089 95 ci 018 430 1 trial 232 women lowcertainty evidence maternal adverse events reported none studies assessed neonatal drug adverse effects single dose paracetamol may improve perineal pain relief following vaginal birth may reduce need additional pain relief potential adverse effects women neonates appropriately assessed trials also address gaps evidence concerning maternal outcomes satisfaction postnatal care maternal functioningwellbeing emotional attachment selfefficacy competence autonomy confidence selfcare coping skills neonatal drug adverse effects