Effect of Acupoint Hot Compress on Postpartum Urinary Retention After Vaginal Delivery: A Randomized Clinical Trial.

Acupoint hot compress during the early postpartum period may benefit patients after a vaginal delivery, but the evidence of this effect is limited.

To assess whether acupoint hot compress involving the abdominal, lumbosacral, and plantar regions could reduce the incidence of postpartum urinary retention, relieve postpartum uterine contraction pain, prevent emotional disorders, and promote lactation.

This multicenter randomized clinical trial was conducted at 12 hospitals in China. Pregnant patients were screened for eligibility (n = 13 949) and enrolled after vaginal delivery (n = 1200) between January 17 and August 15, 2021; data collection was completed on August 18, 2021. After vaginal delivery, these participants were randomized 1:1 to either the intervention group or control group. Statistical analysis was based on per-protocol population.

Participants in the control group received routine postpartum care. Participants in the intervention group received routine postpartum care plus 3 sessions of a 4-hour acupoint hot compress involving the abdominal, lumbosacral, and plantar regions within 30 minutes, 24 hours, and 48 hours after delivery.

The primary outcome was the incidence of postpartum urinary retention, defined as the first urination occurring more than 6.5 hours after delivery and/or use of an indwelling catheter within 72 hours after delivery. The secondary outcomes were postpartum uterine contraction pain intensity (assessed with the visual analog scale [VAS]), depressive symptoms (assessed with the Edinburgh Postnatal Depression Scale), and lactation conditions (including lactation initiation time, breastfeeding milk volume, feeding mood and times, and newborn weight).

Of the 1200 participants randomized, 1085 completed the study (537 in the intervention group and 548 in the control group, with a median [IQR] age of 26.0 [24.0-29.0] years). Participants in the intervention group compared with the control group had significantly decreased incidence of postpartum urinary retention (relative risk [RR], 0.58; 95% CI, 0.35-0.98; P = .03); improved postpartum uterine contraction pain when measured at 6.5 hours (median [IQR] VAS score, 1 [1-2] vs 2 [1-2]; P < .001), 28.5 hours (median [IQR] VAS score, 1 [0-1] vs 1 [1-2]; P < .001), 52.5 hours (median [IQR] VAS score, 1 [0-1] vs 1 [0-1]; P < .001), and 76.5 hours (median [IQR] VAS score, 0 [0-1] vs 0 [0-1]; P = .01) after delivery; reduced depressive symptoms (RR, 0.73; 95% CI, 0.54-0.98; P = .01); and increased breastfeeding milk volume measured at 28.5, 52.5, and 76.5 hours after delivery. No adverse events occurred in either of the 2 groups.

Results of this trial showed that acupoint hot compress after vaginal delivery decreased postpartum urinary retention, uterine contraction pain, and depressive symptoms and increased breastfeeding milk volume. Acupoint hot compress may be considered as an adjunctive intervention in postnatal care that meets patient self-care needs.

Chinese Clinical Trial Registry Identifier: ChiCTR2000038417.

JAMA network open. 2022 May 02*** epublish ***

Yuhang Zhu, Fangfang Wang, Jue Zhou, Shuiqin Gu, Lianqing Gong, Yaoyao Lin, Xiaoli Hu, Wei Wang, Aihua Zhang, Dongmei Ma, Chunxiao Hu, Yan Wu, Lanzhong Guo, Limin Chen, Leiyin Cen, Yan He, Yuqing Cai, Enli Wang, Honglou Chen, Jing Jin, Jinhe Huang, Meiyuan Jin, Xiujuan Sun, Xiaojiao Ye, Linping Jiang, Ying Zhang, Jian Zhang, Junfei Lin, Chunping Zhang, Guofang Shen, Wei Jiang, Liuyan Zhong, Yuefang Zhou, Ruoya Wu, Shiqing Lu, Linlin Feng, Hong Guo, Shanhu Lin, Qiaosu Chen, Jinfang Kong, Xuan Yang, Mengling Tang, Chang Liu, Fang Wang, Xiao-Yang Mio Hu, Hye Won Lee, Xinfen Xu, Rong Zhang, Nicola Robinson, Myeong Soo Lee, Jisheng Han, Fan Qu

Department of Chinese Integrative Medicine, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China., School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China., Department of Obstetrics, Jiaxing Maternity and Child Health Care Hospital, Jiaxing, China., Department of Obstetrics, Yiwu Maternity and Child Health Care Hospital, Yiwu, China., Department of Epidemiology and Biostatistics at School of Public Health and the Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China., Department of Obstetrics, Tongde Hospital of Zhejiang Province, Hangzhou, China., Department of Obstetrics, Xianju People's Hospital, Xianju, China., Department of Obstetrics, The Women and Children Hospital of Dongyang, Dongyang, China., Department of Obstetrics, Shaoxing Maternity and Child Health Care Hospital, Shaoxing, China., Department of Obstetrics, Cixi Maternity and Child Health Care Hospital, Cixi, China., Department of Obstetrics, Zhoushan Women and Children Hospital, Zhoushan, China., Department of Obstetrics, Ruian People's Hospital, Ruian, China., Department of Obstetrics, Wenling Maternity and Child Health Care Hospital, Wenling, China., Department of Obstetrics, Zhejiang Xiaoshan Hospital, Hangzhou, China., Department of Obstetrics, The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China., Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom., Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea., Neuroscience Research Institute, Peking University, Beijing, China., School of Health and Social Care, London South Bank University, London, United Kingdom.

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