Aspirin (single dose) for perineal pain in the early postpartum period

Perineal trauma (due to spontaneous tears, surgical incision (episiotomy) or in association with operative vaginal birth) is common after vaginal birth, and is often associated with postpartum perineal pain. Birth over an intact perineum may also lead to perineal pain. There are adverse health consequences associated with perineal pain for the women and their babies in the short- and long-term, and the pain may interfere with newborn care and the establishment of breastfeeding. Aspirin has been used in the management of postpartum perineal pain and its effectiveness and safety should be assessed.To determine the efficacy of a single dose of aspirin (acetylsalicylic acid), including at different doses, in the relief of acute postpartum perineal pain.We searched Cochrane Pregnancy and Childbirth's Trials Register (30 August 2016), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (31 May 2016) and reference lists of retrieved studies. Randomised controlled trials (RCTs) assessing single dose aspirin compared with placebo, no treatment, a different dose of aspirin, or single dose paracetamol/acetaminophen for women with perineal pain in the early postpartum period. We planned to include cluster-RCTs but none were identified. Quasi-RCTs and cross-over studies were not eligible for inclusion in this review.Two review authors independently assessed study eligibility, extracted data and assessed the risk of bias of the included RCTs. Data were checked for accuracy. The quality of the evidence for the main comparison (aspirin versus placebo) was assessed using the GRADE approach.We included 17 RCTs, with 16 involving 1132 women randomised to aspirin or placebo (one RCT did not report numbers of women). Two RCTs (of 16) did not contribute data to review meta-analyses. All women had perineal pain post-episiotomy, and were not breastfeeding. Studies were published between 1967 and 1997, and the risk of bias was often unclear due to poor reporting.We included four comparisons: aspirin versus placebo (data from 15 RCTs); 300 mg versus 600 mg aspirin (1 RCT); 600 mg versus 1200 mg aspirin (2 RCTs); and 300 mg versus 1200 mg aspirin (1 RCT). Primary outcomes Aspirin versus placeboMore women who received aspirin experienced adequate pain relief compared with women who received placebo over four to eight hours after administration (risk ratio (RR) 2.03, 95% confidence intervals (CI) 1.69 to 2.42; 13 RCTs, 1001 women; low-quality evidence). Women who received aspirin were less likely to need additional pain relief over four to eight hours after administration (RR 0.25, 95% CI 0.17 to 0.37; 10 RCTs, 744 women; very low-quality evidence). There was no difference in maternal adverse effects over four to eight hours post-administration (RR 1.08, 95% CI 0.57 to 2.06; 14 RCTs, 1067 women; very low-quality evidence). Subgroup analyses based on dose did not reveal any clear subgroup differences.There was no clear difference over four hours after administration between 300 mg and 600 mg aspirin for adequate pain relief (RR 0.82, 95% CI 0.36 to 1.86; 1 RCT, 81 women) or need for additional pain relief (RR 0.68, 95% CI 0.12 to 3.88; 1 RCT, 81 women). There were no maternal adverse effects in either aspirin group.There was no clear difference over four to eight hours after administration between 600 mg and 1200 mg aspirin for adequate pain relief (RR 0.85, 95% CI 0.52 to 1.39; 2 RCTs, 121 women), need for additional pain relief (RR 1.32, 95% CI 0.30 to 5.68; 2 RCTs, 121 women), or maternal adverse effects (RR 3.00, 95% CI 0.13 to 69.52; 2 RCTs, 121 women).There was no clear difference over four hours after administration between 300 mg and 1200 mg aspirin for adequate pain relief (RR 0.62, 95% CI 0.29 to 1.32; 1 RCT, 80 women) or need for additional pain relief (RR 2.00, 95% CI 0.19 to 21.18; 1 RCT, 80 women). There were no maternal adverse effects in either aspirin group.None of the included RCTs reported on neonatal adverse effects. Secondary outcomesNo studies reported on secondary review outcomes: prolonged hospitalisation due to perineal pain; re-hospitalisation due to perineal pain; fully breastfeeding at discharge; mixed feeding at discharge; fully breastfeeding at six weeks; mixed feeding at six weeks; perineal pain at six weeks; maternal views; maternal postpartum depression.We found low-quality evidence to suggest that single dose aspirin compared with placebo can increase pain relief in women with perineal pain post-episiotomy. Very low-quality evidence also suggested that aspirin can reduce the need for additional analgesia, without increasing maternal adverse effects. Evidence was downgraded based on study limitations (risk of bias), imprecision, and publication bias or both. RCTs excluded breastfeeding women so there is no evidence to assess the effects of aspirin on neonatal adverse effects or breastfeeding.With international guidance recommending mothers initiate breastfeeding within one hour of birth, and exclusively breastfeed for the first six months, the evidence from this review is not applicable to current recommended best practice. Aspirin may be considered for use in non-breastfeeding women with post-episiotomy perineal pain. Although formal assessment was beyond the remit of this review, current guidance suggests that other analgesic drugs (including paracetamol) should be considered first for postpartum perineal pain. Such agents are the focus of other reviews in this series on drugs for perineal pain in the early postpartum period. It is considered most likely that if RCTs are conducted in the future they could compare aspirin with other pain relievers. Future RCTs should be designed to ensure high methodological quality, and address gaps in the evidence, such as the secondary outcomes established for this review. Current research has focused on women with post-episiotomy pain, future RCTs could be extended to women with perineal pain associated with spontaneous tears or operative birth.Molakatalla S, Shepherd E, Grivell R

Field Evaluation of Asphalt Film Thickness as a Design Parameter in Superpave Mix Design

Research shows that asphalt film thickness (AFT) is related to mix performance. The use of AFT as a mix design parameter has always been a challenge because of the complexity of estimating AFT based on mix parameters. The aggregate surface area and the effective volume of asphalt are important components in the calculation of AFT. This study compares the voids in mineral aggregate (VMA) and AFT as mix design parameters against the field performance of Superpave mixes. Film thickness was estimated by different formulas using calculated aggregate surface area. Data on early flushing sections of Superpave mixes was used to correlate film thickness to distress development and other mix design parameters. The pavement sections considered for the study were observed to have undergone flushing and rutting problems. Field cores from flushed and non-flushed sections were obtained and verified for compliance with Superpave specifications. The results of this research related AFT to mix design parameters but showed that depending on the method of calculation, AFT, as a mix design parameter, may or may not be helpful in explaining specific field performance distresses such as rutting or bleeding

Travel Demand Modeling for the Small and Medium Sized MPOs in Illinois

Travel demand modeling is an important tool in the transportation planning community. It helps forecast travel characteristics into the future at various planning levels such as state, region and corridor. Using travel demand modeling to evaluate different situations (changes in land use and/or transportation network) would allow Metropolitan Planning Organizations’ (MPOs) staff make educated decisions regarding growth and improvements to their respective regional transportation networks. Several small (50,000< population <200,000) and medium (200,000 <population <500,000) sized MPOs in the state of Illinois utilize TDM for different transportation planning purposes, most commonly, the Long Range Transportation Plan (LRTP) and Transportation Improvement Program (TIP). Some of the small and medium sized MPOs in the state of Illinois are unable to utilize TDM tools primarily due to lack of available resources and guidelines at the regional and state level. This study sought to establish the framework necessary for the development, maintenance, and application of small and medium sized MPOs’ TDMs. It is crucial for the local, regional, and state agencies to play a collaborative role in the transportation planning process. This study established a framework for developing travel demand models at the MPO regional level considering their limited available resources. Special attention was given to simplicity and accuracy of the travel model development process. Extensive calibration and validation checks were recommended, as accuracy of travel forecasting is of high importance. As an important part of this study, a statewide group, the Illinois Modeling Users Group (IL-MUG) was created to support, set standards and guide the development, implementation, and maintenance of travel demand models in small and medium sized MPOs in Illinois.Illinois Department of Transportation ICT R27-48published or submitted for publicationnot peer reviewe