Treatments for breast engorgement during lactation.
BACKGROUND
Breast engorgement is a painful and unpleasant condition affecting large numbers of women in the early postpartum period. During a time when mothers are coping with the demands of a new baby it may be particularly distressing. Breast engorgement may inhibit the development of successful breastfeeding, lead to early breastfeeding cessation, and is associated with more serious illness, including breast infection.


OBJECTIVE
To identify the best forms of treatment for women who experience breast engorgement.


METHODS
We identified studies for inclusion through the Cochrane Pregnancy and Childbirth Group's Trials Register (February 2010).


METHODS
Randomised and quasi-randomised controlled trials where treatments for breast engorgement were evaluated.


METHODS
Two review authors assessed eligibility for inclusion and carried out data extraction.


RESULTS
We included eight studies with 744 women. Trials examined a range of different treatments for breast engorgement: acupuncture (two studies), cabbage leaves (two studies), cold gel packs (one study), pharmacological treatments (two studies) and ultrasound (one study). For several interventions (ultrasound, cabbage leaves, and oxytocin) there was no statistically significant evidence that interventions were associated with a more rapid resolution of symptoms; in these studies women tended to have improvements in pain and other symptoms over time whether or not they received active treatment. There was evidence from one study that, compared with women receiving routine care, women receiving acupuncture had greater improvements in symptoms in the days following treatment, although there was no evidence of a difference between groups by six days, and the study did not have sufficient power to detect meaningful differences for other outcomes (such as breast abscess). A study examining protease complex reported findings favouring intervention groups although it is more than 40 years since the study was carried out, and we are not aware that this preparation is used in current practice. A study looking at cold packs suggested that the application of cold does not cause harm, and may be associated with improvements in symptoms, although differences between control and intervention groups at baseline mean that results are difficult to interpret.


CONCLUSIONS
Allthough some interventions may be promising, there is not sufficient evidence from trials on any intervention to justify widespread implementation. More research is needed on treatments for this painful and distressing condition.
Mangesi
Lindeka
L
Epidemiological Research and Surveillance Management Directorate, Eastern Cape Department of Health, Private Bag X0038, Bisho, South Africa, 5605.
Dowswell
Therese
T
D015670:Acupuncture Therapy; D001937:Brassica; D001941:Breast Diseases / Q000209:etiology / Q000628:therapy*; D017679:Cryotherapy / Q000379:methods; D005260:Female; D006801:Humans; D007775:Lactation Disorders / Q000628:therapy*; D010121:Oxytocin / Q000627:therapeutic use; D010447:Peptide Hydrolases / Q000627:therapeutic use; D008517:Phytotherapy / Q000379:methods; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D014464:Ultrasonic Therapy / Q000379:methods
D010121:Oxytocin; D010447:Peptide Hydrolases
Am J Obstet Gynecol. 1959 Jul;78(1):80-5
13661250
Singapore Med J. 1989 Feb;30(1):48-54
2688125
J Hum Lact. 1995 Mar;11(1):17-20
7718101
Midwifery. 2007 Jun;23(2):184-95
17052823
Obstet Gynecol. 1966 Jan;27(1):73-7
5948031
Obstet Gynecol. 1956 Apr;7(4):422-4
13309914
Aust J Physiother. 1991;37(1):23-8
25026196
J Jpn Obstet Gynecol Soc. 1965 Jul;12(3):139-47
5330306
Aesthetic Plast Surg. 2005 Jul-Aug;29(4):274-9; discussion 280
15948017
Acta Obstet Gynecol Scand. 1953;32(4):399-402
13138066
Eur J Pediatr. 1997 Nov;156(11):874-7
9392404
Am J Obstet Gynecol. 1970 Sep 15;108(2):240-2
4952576
Obstet Gynecol. 1962 Nov;20:582-4
13975749
Cochrane Database Syst Rev. 2007 Jan 24;(1):CD001141
17253455
J Hum Lact. 2006 Aug;22(3):315-21
16885491
J Hum Lact. 1995 Sep;11(3):191-4
7669238
Clin Obstet Gynecol. 2004 Sep;47(3):676-82
15326430
Cochrane Database Syst Rev. 2005 Apr 18;(2):CD001688
15846621
Biometrics. 1992 Jun;48(2):577-85
1637980
Rural Remote Health. 2006 Apr-Jun;6(2):495
16732696
Int Nurs Rev. 2004 Mar;51(1):56-64
14764015
J Natl Med Assoc. 2005 Jul;97(7):1010-9
16080672
J Hum Lact. 1998 Sep;14(3):231-6
10205435
Cochrane Database Syst Rev. 2001;(2):CD000046
11405948
J Ark Med Soc. 1975 Sep;72(4):163-7
127773
BMJ. 1999 Aug 7;319(7206):376-9
10435968
Immunology. 1999 Aug;97(4):595-600
10457212
Am J Obstet Gynecol. 1962 Oct 1;84:969-71
13916819
J Pediatr (Rio J). 2004 Nov;80(5 Suppl):S147-54
15583765
Pediatrics. 2002 Nov;110(5):e59
12415065
Birth. 1993 Jun;20(2):61-4
8240608