Effects of high volume saline enemas vs no enema during labour--The N-Ma Randomised Controlled Trial [ISRCTN43153145]. Enema versus no-enema in pregnant women on admission in labor: a randomized controlled trial. A controlled trial on wound drainage in caesarean section.
Enemas are used during labour in obstetric settings with the belief that they reduce puerperal and neonatal infections, shorten labour duration, and make delivery cleaner for attending personnel. However, a systematic review of the literature found insufficient evidence to support the use of enemas. The objective of this RCT was to address an identified knowledge gap by determining the effect of routine enemas used during the first stage of labour on puerperal and neonatal infection rates.
                
                RCT (randomised controlled trial; randomized clinical trial).
                Clinical diagnosis of maternal or neonatal infections, labour duration, delivery types, episiotomy rates, and prescription of antibiotics.
                Tertiary care referral hospital at the Javeriana University (Bogotá, Colombia) that attended 3170 births during study period with a caesarean section rate of 26%.
                443 women admitted for delivery to the obstetrics service (February 1997 to February 1998) and followed for a month after delivery. Inclusion criteria were women with: low risk pregnancy and expected to remain in Bogotá during follow up; gestational age > or = 36 weeks; no pelvic or systemic bacterial infection; intact membranes; cervix dilatation < or = 7 cm.
                1 litre saline enema, versus no enema, allocated following a block random allocation sequence and using sealed opaque envelopes.
                Allocation provided balanced groups and 86% of the participants were followed up for one month. The overall infection rate for newborns was 21%, and 18% for women. We found no significant differences in puerperal or neonatal infection rates (Puerperal infection: 41/190 [22%] with enema v 26/182 [14%] without enema; RR 0.66 CI 95%: 0.43 to 1.03; neonatal infection 38/191 [20%] with enema v 40/179 [22%] without enema; RR 1.12, 95% CI 95% 0.76 to 1.66), and median labour time was similar between groups (515 min. with enema v 585 min. without enema; P = 0.24). Enemas didn't significantly change episiorraphy dehiscence rates (21/182 [12%] with enema v 32/190 [17%] without enema; P = 0.30).
                This RCT found no evidence to support routine use of enemas during labour. Although these results cannot rule out a small clinical effect, it seems unlikely that enemas will improve maternal and neonatal outcomes and provide an overall benefit. To compare the maternal and neonatal outcomes between enema and no-enema in pregnant women on admission in labor.
                One thousand and one hundred term pregnant women with labor pain were selected randomly on admission to be assigned into two groups at Rajavithi Hospital from 1 February 2002 to 15 June 2002. Five -hundred and thirty-nine cases received enema and five-hundred and sixty one cases received noenema. Seventy three women (39 and 34 cases from the enema and no-enema groups, respectively) were excluded because of cesarean section due to obstetric indications. Five hundred cases received enema and five-hundred and twenty -seven cases received no-enema. All cases were delivered vaginally.
                There was no statistical significant difference between the two groups with regards to maternal age, gestational age, gravidity, parity, mode of delivery, type of episiotomy and degree of perineal tear. Fecal contamination rate during the second stage of labor was significantly higher in the women who received no-enema (34.9%) in comparision with those receiving enema (22.8% (p < 0.001). No neonatal infection occurred in both groups. Duration of labor was significantly longer in the women who received no-enema (459.8 min) compared with those who received enema (409.4 min) (p < 0.001).
                No-enema methods on admission in labor had significantly more increase infecal contamination in the second stage of labor and longer duration of labor than the enema method But there was no difference in perineal wound infection and neonatal infection between both groups. A randomized controlled trial was carried out to investigate the influence of drainage on wound infection following Caesarean section. The incidence of clinical wound infection was significantly reduced if a Redivac suction drain was placed beneath the rectus sheath. Subcutaneous corrugated drains were found to offer no advantage. Three different degrees of postoperative pyrexia are examined for their predictive value for the development of wound sepsis. The influence of duration of amnion rupture and the number of vaginal examinations in labour on the postoperative incidence of wound infection and pyrexia are examined.
The evidence provided by the four included RCTs shows that enemas do not have a significant beneficial effect on infection rates such as perineal wound infection or other neonatal infections and women's satisfaction. These findings speak against the routine use of enemas during labour, therefore, such practice should be discouraged.