21. (9.) Results by individual review ‐ TENS.
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9. Transcutaneous electrical nerve stimulation (TENS) for pain management in labour, 17 studies, 1455 women (Dowswell 2009) | |||
| 9.1. TENS versus placebo or standard care (17 studies, 1455 women) | Outcome | No. of studies (no. women) | Results |
| TENS (to the back) versus placebo/usual care | Pain intensity – number of women reporting severe pain during labour | 2 (147) | Average RR 0.67, 95% CI 0.32 to 1.40 (random effects; heterogeneity: I2 = 49%, Tau2 = 0.18, Chi2 test for heterogeneity P = 0.16), no evidence of a significant difference |
| TENS (to the back) versus placebo/usual care | Pain intensity – pain scores | 2 (299) | Average SMD ‐1.01, 95% CI ‐3.00 to 0.97 (random effects: heterogeneity: I2 = 93%, Tau2 = 1.92, Chi2 test for heterogeneity P = 0.0002), no evidence of a significant difference |
| TEN (to the back) versus placebo/usual care | Satisfaction with pain relief | 5 (452) | RR 1.25, 95% CI 0.98 to 1.60, no evidence of a significant difference |
| TENS (to the back) versus usual care | Sense of control in labour | 1 (24) | Data not analysed (standard deviations inconsistent) |
| TENS (to the back) versus usual care | Satisfaction with childbirth experience | 1 (24) | Data not analysed (standard deviations inconsistent) |
| TENS (to the back) versus placebo/usual care |
Effect (negative) on mother/baby interaction | Outcome not reported | |
| TENS (to the back) versus placebo/usual care |
Breastfeeding | Outcome not reported | |
| TENS (to the back) versus placebo/usual care | Assisted vaginal birth | 7 (840) | RR 0.82, 95% CI 0.56 to 1.19, no evidence of a significant difference |
| TENS (to the back) versus placebo/usual care | Caesarean section | 8 (868) | RR 1.35, 95% CI 0.84 to 2.17, no evidence of a significant difference |
| TENS (to the back) versus control | Adverse effects for infants (fetal distress) | 1 (200) | RR 0.33, 95% CI 0.01 to 8.09, no evidence of a significant difference |
| TENS (to the back) versus placebo/usual care |
Admission to special care baby unit/neonatal intensive care unit | Outcome not reported | |
| TENS (to the back) versus placebo/usual care |
Apgar score less than seven at five minutes | Outcome not reported | |
| TENS (to the back) versus placebo/usual care |
Poor infant outcomes at long‐term follow‐up | Outcome not reported | |
| TENS (to the back) versus placebo/usual care |
Cost | Outcome not reported | |
| TENS (to acupuncture points) versus placebo | Pain intensity – number of women reporting severe pain during labour | 2 (290) | RR 0.41, 95% CI 0.31 to 0.54, significantly fewer women in TENS group reported severe pain compared with controls |
| TENS (to acupuncture points) versus control (no pain relief) | Satisfaction with pain relief | 1 (90) | RR 4.10, 95% CI 1.81 to 9.29, significantly more women in TENS group were satisfied with pain relief compared with controls |
| TENS (to acupuncture points) versus placebo/control (no treatment) | Sense of control in labour | Outcome not reported | |
| TENS (to acupuncture points) versus placebo/control (no treatment) | Satisfaction with childbirth experience | Outcome not reported | |
| TENS (to acupuncture points) versus placebo/control (no treatment) | Effect (negative) on mother/baby interaction | Outcome not reported | |
| TENS (to acupuncture points) versus placebo/control (no treatment) | Breastfeeding | Outcome not reported | |
| TENS (to acupuncture points) versus placebo | Assisted vaginal birth | 1 (100) | RR 4.50, 95% CI 1.02 to 19.79, significantly more women in TENS group had assisted vaginal births |
| TENS (Limoge current to cranium) versus placebo | Assisted vaginal birth | 1 (20) | RR 0.67, 95% CI 0.14 to 3.17, no evidence of a significant difference |
| TENS (to acupuncture points) versus placebo | Caesarean section | 1 (100) | RR 1.50, 95% CI 0.26 to 8.60, no evidence of a significant difference |
| TENS (Limoge current to cranium) versus placebo | Caesarean section | 1 (20) | RR 1.00, 95% CI 0.07 to 13.87, no evidence of a significant difference |
| TENS (to acupuncture points) versus placebo | Adverse effects for infants (fetal distress) | 1 (100) | RR 1.00, 95% CI 0.06 to 15.55), no evidence of a significant difference |
| TENS (to acupuncture points) versus placebo/control (no treatment) | Admission to special care baby unit/neonatal intensive care unit | Outcome not reported | |
| TENS (to acupuncture points) versus placebo/control (no treatment) | Apgar score less than seven at five minutes | Outcome not reported | |
| TENS (to acupuncture points) versus placebo/control (no treatment) | Poor infant outcomes at long‐term follow‐up | Outcome not reported | |
| TENS (to acupuncture points) versus placebo/control (no treatment) | Cost | Outcome not reported | |
| 9.2. TENS versus a different type of TENS (no studies) | |||
| 9.3. TENS versus sterile water injection (1 study, 22 women) | Outcome | No. of studies (no. women) | Results |
| Pain intensity ‐ pain score measured using visual analogue scale (VAS) in labour | 1 (22) | SMD 5.45, 95% CI 3.49 to 7.42, women in the TENS group more likely to have a higher mean pain score than women in the sterile water group, "The study measured pain on a scale with scores recorded in millimetres, it was not clear how the 10 cm scale was labelled and the reported standard deviations are much smaller than would be expected with this type of scale, therefore results should be interpreted with caution". | |
| Satisfaction with pain relief | Outcome not reported | ||
| Sense of control in labour | 1 (22) | Data not suitable for analysis | |
| Satisfaction with childbirth experience | 1 (22) | Data not suitable for analysis | |
| Effect (negative) on mother/baby interaction | Outcome not reported | ||
| Breastfeeding | Outcome not reported | ||
| Assisted vaginal birth | Outcome not reported | ||
| Caesarean section | 1 (22) | RR 7.62, 95% CI 0.46 to 126.40, no evidence of a significant difference | |
| Adverse effects | Outcome not reported | ||
| Admission to special care baby unit/neonatal intensive care unit | Outcome not reported | ||
| Apgar score less than seven at five minutes | Outcome not reported | ||
| Poor infant outcomes at long‐term follow‐up | Outcome not reported | ||
| Cost | Outcome not reported | ||
I2 values reported in table only when random effects analysis has been carried out due to substantial heterogeneity indicated by an I2 value greater than 30% CI: confidence interval; RR: risk ratio; SMD: standardised mean difference