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H. Elkhawaga1, A.H. Bekhet1, A. Sabbahi2,3
1Cairo University, Faculty of Physical Therapy, Giza, Egypt, 2South College, School of Physical Therapy, Knoxville, TN, United States, 3College of Applied Health Sciences, University of Illinois at Chicago, Department of Physical Therapy, Chicago, United States
Background: Episiotomy is a surgical incision in the perineum to increase vaginal diameter and facilitate the delivery of the fetus. Episiotomy is performed in the second-stage of labor during peak contraction to prevent perineal tears. Episiotomy is associated with postpartum pain and complicated healing. Several pharmacological and non-pharmacological methods are used to manage perineal pain and facilitate healing after episiotomy. Low-Level laser therapy (LLLT) is a non-pharmacological modality reported to decrease pain and stimulate healing. To the best of our knowledge, no systematic reviews with meta-analysis investigating the efficacy of LLLT on pain and healing post episiotomy have been performed.
Purpose: This systematic review and meta-analysis aim to investigate the efficacy of LLLT on perineal pain and healing in episiotomy management.
Methods: A computerized literature search of PubMed, PEDro, Scopus, Web of Science, and Cochrane Central was performed using relevant keywords in September 2020. Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) in the English language were eligible if they evaluated LLLT intervention for episiotomy using at least one outcome of perineal pain scale, the Redness, Edema, Ecchymosis, Discharge, Approximation (REEDA) scale of healing, and/or number of complicated healing. Search results were screened for eligibility criteria. The PEDro scale was used to assess the methodological quality of RCTs and CCTs. After data extraction, Review manager version 5.4 was used for meta-analysis.
Results: Three high-quality RCTs and one low-quality CCT with a total of 1560 females were included in the study. The mean difference (MD) of change in the perineal pain scale from baseline to endpoint did not favor LLLT group over placebo before the second and third sessions or after each of the three sessions. While the overall effect was not in favor of LLLT group after the third session (MD -1.21, 95% CI [-2.42, 0.00]), there was a statistically significant difference in the follow up from 7 to 10 days after childbirth (MD -2.40, 95% CI [-4.53, -0.27]). Regarding REEDA scale, analysis showed no statistically significant difference in MD between LLLT group and placebo before the second session (MD 0.28, 95% CI [-0.59, 1.15]), third session (MD 0.00, 95% CI [-0.85, 0.85]), and in the follow up (MD 0.33, 95% CI [-0.52, 1.18]). In terms of number of complicated healing, the effect estimate of the low-quality CCT favored LLLT group over control (RR 0.03, 95% CI [0.01, 0.11]).
Conclusion(s): LLLT did not significantly improve perineal pain score and REEDA scale of healing in females with episiotomy after and before sessions. Only one study reported perineal pain score in follow up from 7 to 10 days after childbirth and showed a significant difference in favor of LLLT. A low-quality trial showed that LLLT significantly decreased healing complications. Current evidence is not enough to confirm LLLT efficacy on perineal pain and healing after episiotomy. Therefore, further high-quality trials with increased sample size and follow-up are needed.
Implications: LLLT might not be an effective modality for episiotomy management. Further research is recommended.
Funding, acknowledgements: There are no funding sources supporting this work.
Keywords: Low level laser therapy, Episiotomy, Meta-analysis
Topic: Pelvic, sexual and reproductive health
Did this work require ethics approval? No
Institution: Cairo University, Faculty of Physical Therapy, Giza, Egypt
Committee: Cairo University, Faculty of Physical Therapy, Giza, Egypt
Reason: This study was not a human trial research. Only using data from previous studies for systematic reviews and meta-analyses.
All authors, affiliations and abstracts have been published as submitted.
