Effectiveness of photobiomodulation therapy on pain intensity in postpartum women with nipple or perineal trauma: protocol for a multicentre, double-blinded, parallel-group, randomised controlled trial.

INTRODUCTION: Photobiomodulation (PBM) using low-level laser can affect tissue repair mechanisms and seems promising in reducing pain intensity. However, few studies support the effectiveness of PBM on postpartum period complications, such as nipple and/or perineal trauma and pain, probably due to the low doses used. The primary objective of this study is to analyse the effectiveness of PBM on pain intensity in the nipple and perineal trauma in women in the immediate postpartum period. Secondary objectives are to evaluate the effect on tissue healing and the women's satisfaction. METHODS AND ANALYSIS: A double-blind, multicentre, parallel-group, randomised controlled trial will be performed in two public referral maternity hospitals in Brazil with 120 participants, divided into two arms: 60 participants in the nipple trauma arm and 60 participants in the perineal trauma arm. Participants will be women in the immediate postpartum period, who present with nipple trauma or perineal trauma and report pain intensity greater than or equal to 4 points on the Numerical Rating Scale for Pain. Block randomisation will be performed, followed by blinding allocation. In the experimental group, one application of PBM will be performed between 6 hours and 36 hours after birth. For the sham group, the simulation will be carried out without triggering energy. Both participants and the research evaluator will be blinded to the allocation group. Intention-to-treat method and the between-group and within-group outcome measures analysis will be performed. ETHICS AND DISSEMINATION: This research protocol was approved by the Research Ethics Committees of the University of Campinas, Brazil, and of the School Maternity Assis Chateaubriand, Brazil (numbers CAAE: 59400922.1.1001.5404; 59400922.1.3001.5050). Participants will be required to sign the informed consent form to participate. Results will be disseminated to the health science community. TRIAL REGISTRATION NUMBER: Brazilian Registry of Clinical Trials (RBR-2qm8jrp).

Pharmacological Treatment for Symptomatic Adenomyosis: A Systematic Review.

OBJECTIVE: To assess the efficacy of non-surgical treatment for adenomyosis. DATA SOURCES: A search was performed by two authors in the Pubmed, Scopus, and Scielo databases and in the grey literature from inception to March 2018, with no language restriction. SELECTION OF STUDIES: We have included prospective randomized studies for treating symptomatic women with adenomyosis (abnormal uterine bleeding and/or pelvic pain) diagnosed by ultrasound or magnetic resonance imaging. DATA COLLECTION: Studies were primarily selected by title and abstract. The articles that were eligible for inclusion were evaluated in their entirety, and their data was extracted for further processing and analysis. DATA SYNTHESIS: From 567 retrieved records only 5 remained for analysis. The intervention groups were: levonorgestrel intrauterine system (LNG-IUS)(n = 2), dienogest (n = 2), and letrozole (n = 1). Levonorgestrel intrauterine system was effective to control bleeding when compared to hysterectomy or combined oral contraceptives (COCs). One study assessed chronic pelvic pain and reported that LNG-IUS was superior to COC to reduce symptoms. Regarding dienogest, it was efficient to reduce pelvic pain when compared to placebo or goserelin, but less effective to control bleeding than gonadotropin-releasing hormone (GnRH) analog. Letrozole was as efficient as GnRH analog to relieve dysmenorrhea and dyspareunia, but not for chronic pelvic pain. Reduction of uterine volume was seen with aromatase inhibitors, GnRH analog, and LGN-IUD. CONCLUSION: Levonorgestrel intrauterine system and dienogest have significantly improved the control of bleeding and pelvic pain, respectively, in women with adenomyosis. However, there is insufficient data from the retrieved studies to endorse each medication for this disease. Further randomized control tests (RCTs) are needed to address pharmacological treatment of adenomyosis.

OBJETIVO: Avaliar a eficácia de tratamento não cirúrgico para adenomiose. FONTES DE DADOS: Uma pesquisa foi realizada por dois autores nas bases de dados Pubmed, Scopus, Scielo e na literatura cinzenta desde o início de cada base de dados até março de 2018, sem restrição de idioma. SELEçãO DE ESTUDOS:: Incluímos estudos prospectivos randomizados para tratamento de mulheres sintomáticas com adenomiose (sangramento uterino anormal e/ou dor pélvica) diagnosticadas por ultrassonografia ou ressonância magnética. COLETA DE DADOS: Os estudos foram selecionados principalmente por título e resumo. Os artigos que preencheram os critérios de inclusão foram avaliados na íntegra, e seus dados foram extraídos para posterior processamento e análise. SíNTESE DOS DADOS:: De 567 registros recuperados, somente 5 permaneceram para análise. Os grupos de intervenção foram: sistema intrauterino de levonorgestrel (SIU-LNG) (n = 2), dienogest (n = 2), e letrozol (n = 1). O SIU-LNG foi efetivo no controle do sangramento quando comparado à histerectomia ou aos contraceptivos orais combinados (COCs). Um estudo avaliou a dor pélvica crônica e relatou que o SIU-LNG foi superior ao COC para reduzir os sintomas. Em relação ao dienogest, este foi eficiente em reduzir a dor pélvica quando comparado ao placebo ou à goserelina, mas foi menos eficaz no controle do sangramento do que o análogo do hormônio liberador de gonadotropina (GnRH). O letrozol foi tão eficiente quanto o análogo do GnRH para aliviar a dismenorreia e a dispareunia, mas não para a dor pélvica crônica. Redução do volume uterino foi observada com inibidores de aromatase, análogo de GnRH, e SIU-LNG. CONCLUSãO:: O SIU-LNG e dienogest apresentaram bons resultados para o controle de sangramento e dor pélvica, respectivamente, em mulheres com adenomiose. No entanto, não há dados suficientes para endossar cada medicação para tratar essa doença. Futuros estudos randomizados são necessários para avaliar o tratamento farmacológico da adenomiose.

Avaliação de desconfortos musculoesqueléticos em gestantes saudáveis e com diabetes gestacional / Evaluation of skeletal muscle discomfort healthy pregnant women and with Gestational Diabetes

Introdução: O Diabetes Mellitus Gestacional (DMG) pode levar à morbidades maternas e fetais quando o diagnóstico é inadequado e tardio. O peso excessivo na gestação e a obesidade atuam como fatores de risco para ocorrência de desconfortos musculoesqueléticos. Objetivo: Avaliar os desconfortos musculoesqueléticos em gestantes saudáveis e com DMG. Materiais e métodos: Estudo descritivo, realizado por meio da análise dos Questionários de Desconforto Musculoesquelético Percebido, com dez gestantes, divididas em G1 (saudáveis) e G2 (DMG), aprovado pelo Comitê de Ética em Pesquisa da USC, sob o protocolo nº007/11. Optou-se pela amostragem por acessibilidade, sendo incluídas as que frequetavam as Unidades Básicas de Saúde, a Unidade Integrada de Atendimento Ambulatorial e Urgência e de uma Unidade de Estratégia Saúde da Família de Bauru. Verificou-se dados sociodemográficos, índice de massa corpórea, idade gestacional e avaliou-se a ocorrência e características dos desconfortos musculoesquelético por meio do Questionário padronizado. Os dados foram submetidos à análise estatística descritiva. Resultados: Observou-se no G1 desconfortos musculoesqueléticos do tipo formigamento, localizados nos membros inferiores, de intensidade moderada a forte, com frequência diária e duração de várias horas. No G2 identificou-se a prevalência de dor na região lombossacra, de intensidade forte a insuportável, com frequência de quase todo dia, com duração de várias horas. Conclusão: Há variações quanto à local e intensidade dos desconfortos musculoesquelético sem ambos os grupos, porém observa-se uma predominância de dores lombares no G2. Sugere-se outros estudos com amostragem maior, para se obter panorama dos desconfortos em gestantes saudáveis e com DMG.

Introduction: The GDM can to take to fetal and maternal morbidity when the diagnostic is inadequate and late. The excess weight in gestation and the obesity contribute as risk factors to the incidence of the skeletal muscle discomfort. Objective: to evaluate the skeletal muscle discomfort in healthy pregnant women and with GDM. Materials and methods: A descriptive study, realized through the analyses of noticed skeletal muscle discomfort questionnaire, with 10 pregnant women, divided into 2 groups: G1 (healthy) and G2 (GDM), approved by the Ethics Committee for Research of USC, protocol n° 007/11. The sampling was selected by accessibility, being included the ones who attended the Basic Health Unit, Integrated Ambulatory Care Unit and Emergency Unit and the Family Health Strategy of Bauru. It was checked social demographic data, body, mass index, gestational age and it was evaluated the occurrence and characteristics of skeletal muscle discomfort, through the employment of a standardized questionnaire. Results: Can be observed in the G1, skeletal muscle discomfort characterized as formication, in inferior limbs, moderate intensity to strong pain, daily, lasting several hours. In the G2 it was identified the prevalence of pain in the lumbar sacral region, intensity to strong to unbearable, almost all day, lasting several hours. Conclusion: There are variations as to intensity and location of the skeletal muscle discomfort in both groups, but it can be observed predominance of lumbar pain in the G2. Additional studies are suggested, comprising larger samples, in order to obtain a broader spectrum of discomfort in pregnant healthy women and with GDM.