Post-Graduate Program on Integral Medicine, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Brazil.
Department of Physical Therapy, Universidade Federal de Pernambuco (UFPE), Recife, Brazil.
J Obstet Gynaecol. 2022 Jul;42(5):726-733. doi: 10.1080/01443615.2021.1997959. Epub 2022 Jan 7.
This meta-analysis aimed to evaluate, using the best level of evidence, the possible benefits and advantages of using peanut ball (PB) in women with an epidural during labour on the maternal and neonatal outcomes. This research was conducted using MEDLINE/PubMed, Embase, LILACS, CINAHL, CENTRAL, PEDro, Web of Science and SCOPUS databases, with no period or language restrictions. The terms 'labor' and 'peanut ball' were used. Clinical trials (randomised and non-randomised) were included when comparing a group of parturients using PB with a control group under usual care. Randomised clinical trials (RCTs) or quasi-randomised were eligible for this systematic review. Two reviewers independently screened studies, extracted data and assessed the quality of evidence which was evaluated by the GRADE system. Quantitative analysis through meta-analysis was also applied whenever possible. In this updated review, we included four studies with a total of 818 women in labour after the use of pharmacological analgesia. Our GRADE ratings of evidence ranged from high to low quality. Overall, the included studies varied in their risk of bias, in which most were considered with some concerns. There is high evidence that the use of PB after epidural analgesia reduces the duration of the first period of labour by 87 minutes and moderate evidence that it increases the chance of vaginal delivery 11%. However, there is no evidence about other maternal and neonatal outcomes.Impact Statement The peanut ball (PB) is used after the use of pharmacological analgesia, as it favours the opening of the pelvic canal and helps women to adopt more comfortable postures, but its real effects are not clear. Our results suggest that using the PB reduces the duration of the first period of labour after an epidural and increases the chance of a vaginal birth. These findings recommend the use of a PB after an epidural and further research with women without the use of pharmacological analgesia.
这项荟萃分析旨在使用最佳证据评估，在产妇分娩时使用花生球（PB）对产妇和新生儿结局的可能益处和优势。这项研究使用了 MEDLINE/PubMed、Embase、LILACS、CINAHL、CENTRAL、PEDro、Web of Science 和 SCOPUS 数据库，没有时间或语言限制。使用了“分娩”和“花生球”这两个术语。纳入了比较使用 PB 的产妇组和接受常规护理的对照组的临床试验（随机和非随机）。本系统评价符合随机临床试验（RCT）或准随机试验的条件。两位审查员独立筛选研究、提取数据并评估证据质量，使用 GRADE 系统进行评估。只要有可能，还进行了定量分析（meta 分析）。在这次更新的综述中，我们纳入了四项研究，共有 818 名在使用药物镇痛后分娩的女性。我们的证据质量等级评定范围从高到低。总体而言，纳入的研究在偏倚风险方面存在差异，其中大多数研究被认为存在一些问题。有高证据表明，在硬膜外镇痛后使用 PB 可使第一产程缩短 87 分钟，有中等证据表明它可增加阴道分娩的机会 11%。然而，关于其他母婴结局的证据并不充分。
在使用药物镇痛后，花生球（PB）被用于帮助产妇打开骨盆通道和采用更舒适的姿势，但它的实际效果并不明确。我们的结果表明，使用 PB 可以缩短硬膜外镇痛后的第一产程并增加阴道分娩的机会。这些发现建议在硬膜外镇痛后使用 PB，并进一步对未使用药物镇痛的女性进行研究。
