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- 1. 27/08/2019, 19*11丕仗舒于仍亠仆亳亠 弍仂仍 亢亠仆亳仆 于 仂亟舒 仂弍亰仂 | Cochrane Page 1 of 4https://www.cochrane.org/ru/CD009234/upravlenie-bolyu-u-zhenshchin-v-rodah---obzor Cochrane 舒亟亢仆亠 亟仂从舒亰舒亠仍于舒. 仆仂仄亳仂于舒仆仆亠 亠亠仆亳. 仂 弍仍舒亞仂 亰亟仂仂于. 丕仗舒于仍亠仆亳亠 弍仂仍 亢亠仆亳仆 于 仂亟舒 仂弍亰仂 仂仍, 从仂仂 亢亠仆亳仆 亳仗于舒ﾑ 于 仂亟舒 亰仆舒亳亠仍仆仂 于舒亳亠. 亠从仂仂亠 亢亠仆亳仆 仂舒ﾑ 仂仍从仂 仆亠弍仂仍 弍仂仍, 仂亞亟舒 从舒从 亟亞亳亠 亢亠仆亳仆 仆舒仂亟 弍仂仍 仆亠于仆仂亳仄仂亶. 仂亰亳亳 (仗仂仍仂亢亠仆亳亠) 亢亠仆亳仆 于 仂亟舒, 亟于亳亞舒亠仍仆舒 舒从亳于仆仂, 舒 亳 亠于仂亞舒, 亳仍亳, 仆舒仂弍仂仂, 于亠亠仆仆仂 仄仂亞 仗仂于仍亳 仆舒 仗亠亠仆仂亳仄仂 弍仂仍亳. 仍 仂弍仍亠亞亠仆亳 弍仂仍亳 亳仗仂仍亰ﾑ 仆亠从仂仂亠 仍亠从舒于亠仆仆亠 亳 仆亠仄亠亟亳从舒仄亠仆仂亰仆亠 于仄亠舒亠仍于舒. 仂仄 仂弍亰仂亠 仄 仂亠仆亳仍亳 18 亳亠仄舒亳亠从亳 仂弍亰仂仂于 仗仂 舒亰仍亳仆仄 于仄亠舒亠仍于舒仄, 亳仗仂仍亰亠仄仄 亟仍 仄亠仆亠仆亳 弍仂仍亳 于 仂亟舒, 15 亳亰 从仂仂 弍仍亳 仂从亠亶仆仂于从亳仄亳 仂弍亰仂舒仄亳. 仂仍亳仆于仂 亟仂从舒亰舒亠仍于 仗仂 仆亠仄亠亟亳从舒仄亠仆仂亰仆仄 于仄亠舒亠仍于舒仄 弍仍亳 仂仆仂于舒仆 仂仍从仂 仆舒 仂亟仆仂仄 亳仍亳 亟于 亳仍亠亟仂于舒仆亳, 仗仂仂仄 仗仂仍亠仆仆亠 亟舒仆仆亠 仆亠 磦仍ﾑ 仂从仂仆舒亠仍仆仄亳. 丐亠仄 仆亠 仄亠仆亠亠, 仄 仆舒仍亳, 仂 仗仂亞亢亠仆亳亠 于 于仂亟, 亠仍舒从舒亳, 亳亞仍仂从舒仍于舒仆亳亠 亳 仄舒舒亢 于亠 仂弍仍亠亞舒仍亳 弍仂仍 亳 仗亳于仂亟亳仍亳 从 仍亠亶 亟仂于仍亠于仂亠仆仆仂亳 仂弍仍亠亞亠仆亳亠仄 弍仂仍亳. 仂亞亢亠仆亳亠 亳 亠仍舒从舒亳 舒从亢亠 仗仂仂弍于仂于舒仍亳 仍亠亶 亟仂于仍亠于仂亠仆仆仂亳 仂亢亟亠仆亳亠仄 亠弍亠仆从舒. 亠仍舒从舒亳, 亳 亳亞仍仂从舒仍于舒仆亳亠 仄亠仆舒仍亳 亳仗仂仍亰仂于舒仆亳亠 亳仗仂于 亳 于舒从仄-从舒从仂仂于, 舒 亳亞仍仂从舒仍于舒仆亳亠 舒从亢亠 仄亠仆舒仍仂 亳仍仂 从亠舒亠于 亠亠仆亳亶. 仍仂 仆亠亟仂舒仂仆仂 亟仂从舒亰舒亠仍于, 仂弍 亟亠仍舒 于于仂亟 仂 仂仄, 磦仍ﾑ 仍亳 亞亳仗仆仂亰, 弍亳仂仍仂亞亳亠从舒 仂弍舒仆舒 于磶, 亳仆亠从亳亳 亠亳仍仆仂亶 于仂亟, 舒仂仄舒亠舒仗亳, 亳 亠亰从仂亢仆舒 仍亠从亳亠从舒 仆亠于仆舒 亳仄仍亳 亠从亳于仆仄亳 亟仍 仂弍仍亠亞亠仆亳 弍仂仍亳 于 仂亟舒. 亠仍仂仄, 弍仍仂 弍仂仍亠 亳仍亠亟仂于舒仆亳亶 仗仂 仍亠从舒于亠仆仆仄 于仄亠舒亠仍于舒仄. 仆亞舒仍亳 亰舒从亳亳 舒亰仂舒 亳 从亳仍仂仂亟舒 (Entonox 速) 仂弍仍亠亞舒仍舒 弍仂仍, 仆仂 仆亠从仂仂亠 亢亠仆亳仆 仂舒仍亳 仂仆仍亳于仂, 仂仆仂 亳仍亳 仗仍仂仂 亠弍 于于仂于舒仍亳. 亠仂仗亳仂亳亟仆亠 仍亠从舒于舒 (仆舒仗亳仄亠, 亠亟舒亳于仆亠) 仂弍仍亠亞舒仍亳 弍仂仍 亳 仆亠从仂仂亠 亳亰 仆亳 仗仂仂弍于仂于舒仍亳 弍仂仍亠亶 亟仂于仍亠于仂亠仆仆仂亳 仂弍仍亠亞亠仆亳亠仄 弍仂仍亳 仗仂 舒于仆亠仆亳 仗仍舒亠弍仂 亳仍亳 仂于亳亠仄 仍亠亠仆亳, 仆仂 亟仂于仍亠于仂亠仆仆仂 仂弍仍亠亞亠仆亳亠仄 弍仂仍亳 弍仍舒 仄亠仆亠, 亠仄 仗亳 亳仗仂仍亰仂于舒仆亳亳 仂仗亳舒仂于. 亅仗亳亟舒仍仆舒 舒仆亠亠亰亳 仂弍仍亠亞舒仍舒 弍仂仍, 仆仂 于亠仍亳亳于舒仍舒 亳仍仂 仂亢亟亠仆亳亶 亳仗仂仍亰仂于舒仆亳亠仄 亳仗仂于 亳仍亳 于舒从仄-从舒从仂仂于, 舒 舒从亢亠 亳从 亞亳仗仂亠仆亰亳亳, 亟于亳亞舒亠仍仆 弍仍仂从仂于 (亰舒亟仆ﾑ亳 亟于亳亢亠仆亳亠 仆仂亞), 仍亳仂舒亟从亳 亳 亰舒亟亠亢从亳 仄仂亳. 仂仄弍亳仆亳仂于舒仆仆舒 仗亳仆舒仍仆仂-仗亳亟舒仍仆舒 舒仆亠亠亰亳 仗亳于仂亟亳仍舒 从 弍仂仄 仂弍仍亠亞亠仆亳 弍仂仍亳, 仆仂 亢亠仆亳仆 舒亠 亳仗于舒仍亳 亰亟, 亠仄 仗亳 亳仗仂仍亰仂于舒仆亳亳 仂仍从仂 仗亳亟舒仍仆仂亶 舒仆亠亠亰亳亳, 仂 亰舒亟亠亢从舒 仄仂亳 弍仍舒 仄亠仆亠亠 于亠仂仆仂亶 仗仂弍仍亠仄仂亶. 仍仂从舒亟舒 仆亠于仂于 仗仂仄仂 仄亠仆 舒仆亠亠亳从仂于 仗亳于仂亟亳仍舒 从 亟仂于仍亠于仂亠仆亳 仂弍仍亠亞亠仆亳亠仄 弍仂仍亳, 仆仂 于亰于舒仍舒 仗仂弍仂仆亠 亠从 亞仂仍仂于仂从亢亠仆亳亠, 仗仂仍亳于仂, 仂亠仆亳亠 仗仂从舒仍于舒仆亳, 亳 弍仂仍亠亞仂 亳仍舒 亟亠亠亶 弍仍仂 亠亢亠仆亳亠 舒仂 亠亟亠仆 仂从舒亠仆亳亶 . 舒亠仆亠舒仍仆亠 仂仗亳仂亳亟 (亳仆亠从亳亳 仗亠亳亟亳仆舒 亳 亠亞仂 舒仆舒仍仂亞仂于) 仄亠仆亠亠 亠从亳于仆, 亠仄 仗亳亟舒仍仆舒 舒仆亠亠亰亳, 仆仂 仆亠 弍仍仂 亟仂舒仂仆 亟仂从舒亰舒亠仍于, 仂弍 亟亠仍舒 于于仂亟 仂 仂仄, 磦仍ﾑ 仍亳 仂仆亳 弍仂仍亠亠 亠从亳于仆仄亳, 亠仄 亟亞亳亠 于仄亠舒亠仍于舒 亟仍 仂弍仍亠亞亠仆亳 弍仂仍亳 于 仂亟舒. 亠仍仂仄, 亢亠仆亳仆舒仄 仍亠亟亠 于于仂于舒 于仂弍仂亟 于弍仂舒 仗仂仂弍舒 仂弍仍亠亞亠仆亳 弍仂仍亳, 从仂仂亶, 从舒从 仂仆亳 仂舒ﾑ, 仍亠 仗仂仄仂亢亠 亳仄 于仂 于亠仄 仂亟仂于. 亠仆亳仆舒仄, 从仂仂亠 于弍亳舒ﾑ 仆亠仄亠亟亳从舒仄亠仆仂亰仆亶 仗仂仂弍 从仗亳仂于舒仆亳 弍仂仍亳, 仍亠亟亠 于于仂于舒 亠弍 于仂弍仂亟仆仂, 亳 亠仍亳 仂 仆亠仂弍仂亟亳仄仂, 仗亠亠仂亟亳 仆舒 仍亠从舒于亠仆仆仂亠 于仄亠舒亠仍于仂. 仂 于亠仄 弍亠亠仄亠仆仆仂亳, 亢亠仆亳仆舒仄 仍亠亟亠 舒从舒亰于舒 仂 仗亠亳仄亠于舒 亳 仗仂亠仆亳舒仍仆 仗仂弍仂仆 亠从舒 亟仍 仆亳 亳 亳 亟亠亠亶 仗亳 亳仗仂仍亰仂于舒仆亳亳 舒亰仍亳仆 仄亠仂亟仂于 从仂仆仂仍 弍仂仍亳. 亟亠仍仆亠 亳仍亠亟仂于舒仆亳 仗仂从舒亰舒仍亳 亰仆舒亳亠仍仆亠 于舒亳舒亳亳 于 仂亠仆从亠 舒从亳 亳仂亟仂于, 从舒从 亳仆亠仆亳于仆仂 弍仂仍亳, 舒 仆亠从仂仂亠 于舒亢仆亠 亳仂亟 仂亠仆亳于舒仍亳 亠亟从仂 亳仍亳 亳 仆亳从仂亞亟舒 仆亠 于从仍ﾑ舒仍亳 (仆舒仗亳仄亠, 于于仂 从仂仆仂仍 于 仂亟舒, 亞亟仆仂亠 于从舒仄仍亳于舒仆亳亠, 于亰舒亳仄仂亟亠亶于亳亠 仄舒亠亳 亳 亠弍亠仆从舒, 亰舒舒 亳 亳仂亟 仄仍舒亟亠仆亠于). 亠仂弍仂亟亳仄 亟舒仍仆亠亶亳亠 亳仍亠亟仂于舒仆亳 于 仂弍仍舒亳 仆亠仄亠亟亳从舒仄亠仆仂亰仆 于仄亠舒亠仍于, 仗亳仄亠仆磳仄 亟仍 仗舒于仍亠仆亳 弍仂仍 于 仂亟舒. 于仂亟 舒于仂仂于: Most methods of non-pharmacological pain management are non-invasive and appear to be safe for mother and baby, however, their e!icacy is unclear, due to limited high quality evidence. In many reviews, only one or two trials provided outcome data for analysis and the overall methodological quality of the trials was low. High quality trials are needed. There is more evidence to support the e!icacy of pharmacological methods, but these have more adverse e!ects. Thus, epidural analgesia provides e!ective pain relief but at the cost of increased instrumental vaginal birth. It remains important to tailor methods used to each womans wishes, needs and circumstances, such as anticipated duration of labour, the infant's condition, and any augmentation or induction of labour. A major challenge in compiling this overview, and the individual systematic reviews on which it is based, has been the variation in use of di!erent process and outcome measures in di!erent trials, particularly assessment of pain and its relief, and e!ects on the neonate a"er birth. This made it di!icult to pool results from otherwise similar studies, and to derive conclusions from the totality of evidence. Other important outcomes have simply not been assessed in trials; thus, despite concerns for 30 years or more about the e!ects of maternal
- 2. 27/08/2019, 19*11丕仗舒于仍亠仆亳亠 弍仂仍 亢亠仆亳仆 于 仂亟舒 仂弍亰仂 | Cochrane Page 2 of 4https://www.cochrane.org/ru/CD009234/upravlenie-bolyu-u-zhenshchin-v-rodah---obzor 从舒仍仆仂: The pain that women experience during labour is a!ected by multiple physiological and psychosocial factors and its intensity can vary greatly. Most women in labour require pain relief. Pain management strategies include non-pharmacological interventions (that aim to help women cope with pain in labour) and pharmacological interventions (that aim to relieve the pain of labour). 丶亠仍亳: To summarise the evidence from Cochrane systematic reviews on the e!icacy and safety of non-pharmacological and pharmacological interventions to manage pain in labour. We considered findings from non-Cochrane systematic reviews if there was no relevant Cochrane review. 仆仂于仆亠 亠亰仍舒: We identified 15 Cochrane reviews (255 included trials) and three non-Cochrane reviews (55 included trials) for inclusion within this overview. For all interventions, with available data, results are presented as comparisons of: 1. Intervention versus placebo or standard care; 2. Di!erent forms of the same intervention (e.g. one opioid versus another opioid); 3. One type of intervention versus a di!erent type of intervention (e.g. TENS versus opioid). Not all reviews included results for all comparisons. Most reviews compared the intervention with placebo or standard care, but with the exception of opioids and epidural analgesia, there were few direct comparisons between di!erent forms of the same intervention, and even fewer comparisons between di!erent interventions. Based on these three comparisons, we have categorised interventions into: " What works" ,What may work, and Insu!icient evidence to make a judgement. WHAT WORKS Evidence suggests that epidural, combined spinal epidural (CSE) and inhaled analgesia e!ectively manage pain in labour, but may give rise to adverse e!ects. Epidural, and inhaled analgesia e!ectively relieve pain when compared with placebo or a di!erent type of intervention (epidural versus opioids). Combined-spinal epidurals relieve pain more quickly than traditional or low dose epidurals. Women receiving inhaled analgesia were more likely to experience vomiting, nausea and dizziness. When compared with placebo or opioids, women receiving epidural analgesia had more instrumental vaginal births and caesarean sections for fetal distress, although there was no di!erence in the rates of caesarean section overall. Women receiving epidural analgesia were more likely to experience hypotension, motor blockade, fever or urinary retention. Less urinary retention was observed in women receiving CSE than in women receiving traditional epidurals. More women receiving CSE than low-dose epidural experienced pruritus. WHAT MAY WORK There is some evidence to suggest that immersion in water, relaxation, acupuncture, massage and local anaesthetic nerve blocks or non- opioid drugs may improve management of labour pain, with few adverse e!ects. Evidence was mainly limited to single trials. These interventions relieved pain and improved satisfaction with pain relief (immersion, relaxation, acupuncture, local anaesthetic nerve blocks, non-opioids) and childbirth experience (immersion, relaxation, non-opioids) when compared with placebo or standard care. Relaxation was associated with fewer assisted vaginal births and acupuncture was associated with fewer assisted vaginal births and caesarean sections. INSUFFICIENT EVIDENCE There is insu!icient evidence to make judgements on whether or not hypnosis, biofeedback, sterile water injection, aromatherapy, TENS, or parenteral opioids are more e!ective than placebo or other interventions for pain management in labour. In comparison with other opioids more women receiving pethidine experienced adverse e!ects including drowsiness and nausea. 舒仄亠从亳 仗仂 仗亠亠于仂亟: 亠亠于仂亟: 豫亟亳仆舒 从舒亠亳仆舒 亳从仂仂于仆舒. 亠亟舒从亳仂于舒仆亳亠: 亳亞舒仆亳仆舒 亳仍亳 于亞亠仆亠于仆舒. 仂仂亟亳仆舒亳 仗仂亠从舒 仗仂 仗亠亠于仂亟 仆舒 从亳亶 磶从: 舒亰舒仆从亳亶 亠亟亠舒仍仆亶 仆亳于亠亳亠. opioid administration during labour on subsequent neonatal behaviour and its influence on breastfeeding, only two out of 57 trials of opioids reported breastfeeding as an outcome. We therefore strongly recommend that the outcome measures, agreed through wide consultation for this project, are used in all future trials of methods of pain management. 丼亳舒亶亠 仗仂仍仆亶 亠从 亠亠舒舒...
- 3. 27/08/2019, 19*11丕仗舒于仍亠仆亳亠 弍仂仍 亢亠仆亳仆 于 仂亟舒 仂弍亰仂 | Cochrane Page 3 of 4https://www.cochrane.org/ru/CD009234/upravlenie-bolyu-u-zhenshchin-v-rodah---obzor 仂 于仂仗仂舒仄, 于磶舒仆仆仄 亳仄 仗亠亠于仂亟仂仄, 仗仂亢舒仍亶舒, 于礀亳亠 仆舒仄亳 仗仂 舒亟亠: lezign@gmail.com (mailto:lezign@gmail.com) (/#facebook) (/#twitter) (/#whatsapp) (/#email) (https://www.addtoany.com/share#url=https%3A%2F%2Fwww.cochrane.org%2Fru%2FCD009234%2Fupravlenie-bolyu-u-zhenshchin-v-rodah--- obzor&title=%D0%A3%D0%BF%D1%80%D0%B0%D0%B2%D0%BB%D0%B5%D0%BD%D0%B8%D0%B5%20%D0%B1%D0%BE%D0%BB%D1%8C%D1%8E%20% 仗弍仍亳从仂于舒仆仂: 5 ﾐ術 2013 于仂:: Jones L, Othman M, Dowswell T, Alfirevic Z, Gates S, Newburn M, Jordan S, Lavender T, Neilson JP 仆仂于仆舒 仗仗舒 仂从亠亶仆仂于从亳 弍亰仂仂于: Pregnancy and Childbirth Group (http://pregnancy.cochrane.org) Jones L, Othman M, Dowswell T, Alfirevic Z, Gates S, Newburn M, Jordan S, Lavender T, Neilson J. Pain management for women in labour: an overview of systematic reviews. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD009234. DOI: 10.1002/14651858.CD009234.pub2
- 4. 27/08/2019, 19*11丕仗舒于仍亠仆亳亠 弍仂仍 亢亠仆亳仆 于 仂亟舒 仂弍亰仂 | Cochrane Page 4 of 4https://www.cochrane.org/ru/CD009234/upravlenie-bolyu-u-zhenshchin-v-rodah---obzor