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6.4.2Intervention for the treatment of haemorrhoids

StudyRef.PopulationInterventionOutcomesResultsCommentsStudy typeEL
Wijayanegra et al., 1992198100 pregnant women (12 to 34 weeks of gestation) recruited from an antenatal clinic with first- to third-degree severity of haemorrhoids500 mg oral (hydroxyethyl)rutosides, oral tablet, twice daily for 1 month (n = 48) vs. placebo (n = 49)Symptomatic improvement
Side effects
Fetal outcome (n = 97)
Symptomatic improvement after 2 weeks: 84% improvement in treatment group and 12% improvement in placebo group
After 4 weeks: 94% improvement in treatment group and 14% improvement in placebo group
Treatment group: abdominal discomfort (n = 1) palpitations after 2 weeks (n = 2)
For all 3 patients side effects resolved by 4 weeks
Treatment group (n = 48) 46 normal outcome, 1 preterm delivery, 1 congenital anomaly (mother treated at 34 weeks post-organogenesis)
Placebo group (n = 49): 46 normal outcome, 1 fetal death, 1 preterm delivery, 1 SGA
Data evaluated on 97 patientsDBRP1b
Buckshee et al., 199719950 pregnant women (amenorrhoea > 28 weeks) with history of acute internal haemorrhoidsMicronised flavonoid therapy
Oral tablets (micronised diosmin 450 mg (90% and hesperidin 50 mg (10%)
Three phase treatment:
First phase: 6 tablets for 4 days and 4 tablets for 3 days, divided dose after lunch and dinner
Second and third phase: up to 30 days after delivery, maintenance dose; 2 tablets per day, divided lunch and supper
Self-assessment of acute symptoms (0 absent to 3 severe)
Relapses in the antenatal period and the postnatal period
Side effects
Infant outcomes
Median symptom scores assessed before and after first phase (7 day treatment) for: bleeding reduced by 1 (range 1 to 2), 95% CI, p < 0.001, pain reduced by 1, 95% CI, p < 0.001) rectal exudation reduced by 1, 95% CI p < 0.05 and rectal discomfort reduced by 1, 95% CI p < 0.01
Maintenance treatment: relapses per month before treatment 90% compared with after treatment (maintenance dose) in the antenatal period, 36.3% p < 0.001
Postnatal assessment: pretreatment (history 1 year prior pregnancy), % history with relapse 42% compared with assessment at 30 days post delivery % with relapses 12%
Side effects: nausea and diarrhoea (n = 6)
Congenital malformation (n = 1)
Intrauterine death (n = 1)
Birthweight: median 2.9 kg
(range 2.7 to 3.1)
Recruitment to study: 50 eligible consecutive patientsCSS3
Saleeby et al., 199120025 pregnant women (age range 21 to 34 years)
22 were in 3rd trimester, 80% multiparous
88% presented with thrombosed or gangrenous haemorrhoids
Closed haemorrhoidectomy. Removal of symptomatic disease
3 quadrants removed (n = 14), 2 quadrants removed (n = 7), one quadrant removed (n = 4)
Pain relief
Long term follow up (range 6 months to 6 yrs) mean 30 months
Fetal outcomes
Pain relief in 24 hours (n = 24)
Persistent rectal bleeding (n = 1)
Additional haemorrhoidal treatment required at follow up (n = 6)
No surgical related fetal outcomes

From: Evidence tables

Cover of Antenatal Care
Antenatal Care: Routine Care for the Healthy Pregnant Woman.
NICE Clinical Guidelines, No. 62.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2008 Mar.
Copyright © 2008, National Collaborating Centre for Women’s and Children’s Health.

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