Engorgement Annotated Bibliography Academy of Breastfeeding Medicine August, 2006 REFERENCE Content LEVEL OF EVIDENCE MANAGEMENT STRATEGIES FOR ENGORGEMENT IN LACTATING WOMEN OR BOTH LACTATING AND NON- LACTATING WOMEN Snowden HM, Renfrew MJ, Systematic review of randomized and ‘quasi-randomized’ II-3 Woolridge MW. Treatments for controlled trials that assessed effectiveness of treatments for breast breast engorgement during engorgement in providing symptomatic relief. 8 trials of 424 lactation. Cochrane Database women included. 3 studies used cabbage leaves or extract without Syst Rev. 2001;(2):CD000046 overall benefit. Oxytocin and cold packs were without benefit. Ultrasound was also no better than placebo. An anti-inflammatory agent (Danzen) and bromelain/trypsin complex were found to be superior to placebo in improving symptoms. Nikodem VC, Danzinger D, Randomized controlled trial of 120 women enrolled 72 hours I Gebka N, Gulmezoglu AM, postpartum and assigned to either routine care (60) or to the use of hofmeyr GJ. Do cabbage leaves cold cabbage leaves applied after the next 4 consecutive feeding prevent breast engorgement? A for approximately 20 minutes each or they reached body randomized, controlled study. temperature. Mean number of applications in the treatment group Birth. 1993;20(2):61-4 was 3. A similar number of women from each group regarded their breasts as engorged before the first application (32: treatment vs 29: control). There was no statistically significant difference in the women’s perception of engorgement noted. There was a slight increase in duration of breastfeeding as assessed at 6 week postpartum survey in the treatment group (36 d: treatment vs. 30 d: control, P=0.04). Storr G. Prevention of nipple 37 volunteer healthy primigravida women with uncomplicated III tenderness and breast singleton pregnancies were recruited into the study and served as engorgement in the postpartal their own controls.. Prenatal nipple conditioning was instructed to period. JOGNN 1988 May/June the volunteers including: 1) nipple rolling twice daily for 30 203-209 seconds 2) gently rubbing nipples with a terry towel twice daily for 15 seconds. Breast massage was also instructed to this group and was to be performed 4-5 times after feeds. Nipple preparation was begun at 34 weeks. Massage was initiated in the postpartal period and continued for 4 days. 25 of the women completed the study. The nipple conditioning and breast massage were performed on one breast and the other breast was used as control. Only one participant noted no difference in nipple tenderness. The cumulative tenderness ratings for the other 24 participants noted less overall pain on the experimental side ( p = 0.001). Seven women performing massage noted no difference in engorgement between breasts. Fourteen women performing massage reported less overall engorgement on the experimental side ( p = 0.004). Kee WH, Tan SL, Lee V, 70 symptomatic women who complained of engorgement were I Salmon YM. The treatment of randomized to Danzen 10mg 3 times daily or placebo 3 times breast engorgement with daily for 3 days. All other drugs were withheld during the Engorgement Annotated Bibliography Academy of Breastfeeding Medicine August, 2006 Serrapeptase (Danzen): a treatment period. An independent observer assessed symptoms randomized double-blind based on a 4 point scale beginning prior to therapy and daily controlled study. Singapore during therapy. An improvement rating was then assigned using a Med J. 1989 Feb;30(1):48-54 5 point scale, (1 marked improvement – 5 worsening symptoms). Thirty-five patients were included in each group. Only 4 patients in the Danzen group and 8 in the placebo group breastfed their infants during the study. Three patients in the Danzen group and 5 in the placebo group used massage and pumping during treatment. The improvement ratings revealed marked improvement in 22.9% of the women in the Danzen group as compared to 2.9% in the placebo group. 85.7% in the Danzen group reported either marked or moderate improvement compared to 60% in the placebo group. These differences were statistically significant with P < 0.05. Roberts KL, Reiter M, Schuster 28 exclusively or almost exclusively breastfeeding women were II-2 D. A comparison of chilled and recruited into the study when they noted engorgement. Pain was room temperature cabbage measured pre-treatment and post-treatment. Treatment consisted leaves in treating breast of chilled green cabbage leaves to one breast and room engorgement. J Hum Lact 1995 temperature cabbage leaves to the other for a 2 hour period. A hole Sep; 11(3): 191-4 was cut in the cabbage leaves for the nipple. Discomfort was rated with a questionnaire. Engorgement began on day 2 in 36% and day 3 in 36% of the mothers. 70% stated they had difficulty feeding the baby related to the engorgement. Mean pre-treatment pain rating was 5.4 using the Bourbonnais pain ruler. Post-treatment mean pain rating was 3.3 for chilled cabbage leaves and 3.4 for room temperature leaves. This represented a 37-38% reduction in pain rating which was statistically significant ( p = 0.001) from pre-treatment. There was no statistically significant difference between treatment groups. Cotterman KJ. Reverse pressure Description of reverse pressure softening. Review speculates as to III softening: a simple tool to potential etiology, physiology and predisposing factors leading to prepare areola for easier latching engorgement such as intravenous fluid administration, use of during engorgement. J Hum oxytocin during labor and the use of breastpumps. Basic Lact. 2004 May;20(2):227-37 principles for reverse pressure softening are described and 4 different methods for application are mentioned. Three therapeutic effects of the technique are listed as: 1) stimulation of milk ejection reflex 2) reduction of tension in the walls of the lactiferous sinuses 3) shifting the edema. Roberts KL, A comparison of 34 exclusively or almost exclusively breastfeeding women (20 II-2 chilled cabbage leaves and primipara and 14 multipara) with breast engorgement were chilled gelpaks in reducing enrolled. Chilled cabbage leaves with a hole for the nipple were breast engorgement. J Hum applied to one breast while breast shaped gelpaks were applied to Lact. 1995 Mar;11(1):17-20 the other excluding the nipple. A self administered questionnaire was given before and after treatment and measurement of pain was assessed using a visual analogue scale. Gelpaks and cabbage leaves were renewed “ad lib, usually every 2 to 4 hours”for up to 8 hours. Engorgement occurred between 2 and 6 days postpartum Engorgement Annotated Bibliography Academy of Breastfeeding Medicine August, 2006 with 50% occurring on day 3. Mean onset of engorgement was 3.6 days in primipara and 2.8 days in multiparous women. Prior to treatment, the mean pain rating using the Bourbonnais pain ruler was 5.9. The post treatment mean rating for cabbage leaves was 4.1 and 3.7 for gelpaks.There was no statistically significant difference between treatment groups with both representing a statistically significant reduction in pain from pre-treatment levels ( p = 0.0001). Cabbage leaves reduced pain by 1.8 points (30%) and gelpaks reduced pain by 2.2 points (39%). Sixty-eight % reported relief within 1-2 hours. Roberts KL, Reiter M, Schuster Double blind placebo controlled trial for the treatment of breast II-1 D. Effects of cabbage leaf engorgement in 39 lactating women. The treatment group extract on breast engorgement. J received a cream containing cabbage leaf extract while 18 received Hum Lact. 1998 Sep;14(3):231-6 a placebo cream. Symptoms were evaluated using 4 methods both prior to and after 2 hours of treatment. These were: 1) The Hill and Humenick Breast Engorgement Scale (a 6 point scale) 2) The Bourbonnais pain scale (a visual analogue scale from 0-10) 3) The Roberts Durometer (a device measuring resistance of tissue to the compression of a spring designed to detect tension of hardness) 4) Maternal chest circumference. 54% of mothers reported difficulty in feeding the baby due to engorgement. There was no statistically significant difference in any of the parameters measured by treatment group. The mean decrease in pain after treatment as measured by the Bourbonnais pain scale was 0.8 points. Evans K, Evans R, Simmer K. An opportunity sample of breastfeeding women were assigned to II-1 Effect of the method of breast either the experimental group (n=150) or the control group feeding on breast engorgement, (n=152). The experimental group was asked to empty one breast at mastitis and infantile colic. Acta each feeding alternating which breast was offered first while the Paediatr. 1995 Aug;84(8):849-52 control group was instructed to offer both breasts at each feed. Mothers were seem daily for the first 8 days and infant were weighed on day 3,5 and 8. Questionnaires were administered to evaluate symptoms. There was significantly less breast engorgement in the experimental group (61.4%) than in the control group(74%) p<0.02. There was no difference in infant weight or the incidence of mastitis between groups. There was also less colic in infants followed to 6 months in the experimental compared to the control group (12% verses 23%, p<0.02). Overall, 49% of mothers were still nursing at 6 months. Newton M, Newton N. An observational study of 47 post-partum women using clinical III Postpartum engorgement of the estimations of breast engorgement on average 67 hours after breast. Am J Obstet Gynecol. delivery (range 38-100 hours). The clinical estimation of breast 1951 Mar;61(3):664-7 engorgement was made by an experienced observer, chest circumference just above the nipple was then measured while the patient was lying flat. The amount of milk in the breast was then estimated by allowing infant feeding for 20 – 30 minutes using test weights, followed by electric breast pumping for 5 minutes, Engorgement Annotated Bibliography Academy of Breastfeeding Medicine August, 2006 followed by injection of 0.3 cc of pitocin with subsequent additional pumping for 5 minutes beginning one minute after the pitocin injection.