Adriana Amorim Francisco

Women's experiences of perineal pain during the immediate postnatal period: A cross-sectional study in Brazil

OBJECTIVE To identify the severity and prevalence of perineal pain during the post partum in-patient period and associated obstetric, maternal and newborn baby factors following birth. DESIGN Cross-sectional study. SETTING A postnatal ward of a hospital in São Paulo, Brazil. PARTICIPANTS 303 Postnatal women. MEASUREMENTS Interviews and perineal assessment were conducted to evaluate the perineal outcomes (trauma and pain). Data on maternal characteristics and infant anthropometric variables were collected. RESULTS Among all women, 80.5% had perineal trauma (60.7% had episiotomy) and 18.5% reported perineal pain. The mean pain intensity score was 4.8 ± 1.9 on the visual analogue scale. Only maternal age (ORa = 1.08) and performance of episiotomy (ORa = 3.80) remained as independent predictors of perineal pain in the final logistic regression model. KEY CONCLUSIONS Perineal pain in the immediate postnatal period was highly associated with older maternal age and use of episiotomy, although the overall reporting of perineal pain was low. IMPLICATIONS FOR PRACTICE Perineal pain following vaginal birth is associated with interventions during labour as well as with maternal characteristics. Despite the negative impact on a womans daily activities, perineal pain following birth is neglected by care givers and usually not reported by women who may consider it to be a normal outcome of giving birth. Care providers need to ensure all interventions during labour and birth are informed by evidence of benefit and that barriers to implementation of evidence are addressed. Further work is needed to obtain the views of women in Brazil on their health and well-being following birth.

Avaliação e tratamento da dor perineal no pós-parto vaginal

Objectives: To identify the prevalence, intensity and therapeutic measures for relief of perineal pain in the vaginal postpartum. Methods: Cross-sectional study in a University Hospital Rooming Unit of the University of Sao Paulo; data were collected through interviews with 303 postpartum women who delivered vaginally (numeric scale from 0 to 10) to assess: perineal pain, perineal assessment and medical record data. Results: The prevalence of perineal pain was 18.5%, with moderate intensity (51.8%) associated with presence of episiotomy (p = 0.001). There were 303 vaginal deliveries, 80.5% had perineal trauma, episiotomy, 75.4% and 24.6% lacerations. The oral analgesic was the method used to relieve perineal pain. Conclusion: There are several treatments for perineal pain relief and there are no effective methods for complete resolution of the problem.

Length of perineal pain relief after ice pack application: A quasi-experimental study

INTRODUCTION Ice pack is effective for alleviating postpartum perineal pain in primiparous women while multiparous womens levels of perineal pain appear to be poorly explored. Ice pack is a low-cost non-invasive localised treatment that can be used with no impact on breastfeeding. However, how long perineal analgesia persists after applying an ice pack is still unknown. OBJECTIVE To evaluate if perineal analgesia is maintained up to 2h after applying an ice pack to the perineum for 20min. METHOD A quasi-experimental study, using a pre and post-test design, was undertaken with a sample size of 50 multiparous women in Brazil. Data was collected by structured interview. The intervention involved a single application of an ice pack applied for 20min to the perineal area of women who reported perineal pain ≥3 by use of a numeric rating scale (0-10), with intact perineum, 1st or 2nd degree lacerations or episiotomy, between 6 and 24h after spontaneous vaginal birth. Perineal pain was evaluated at three points of time: before, immediately after and 2h after applying an ice pack. RESULTS Immediately after applying an ice pack to the perineal area, there was a significant reduction in the severity of perineal pain reported (5.4 vs. 1.0, p<0.0005), which continued for 1h 35min up to 2h after the local application. CONCLUSION Ice pack application for 20min is effective for alleviating postpartum perineal pain and continues to be effective between 1h 35min for up to 2h.

Crioterapia no pós-parto: tempo de aplicação e mudanças na temperatura perineal

We present a descriptive study based on the data from two clinical trials conducted at a maternity hospital in Sao Paulo, Brazil, in 2008 and 2009. This study aimed to describe perineal temperature after the application of an ice pack during the postpartum period. Three groups of 38 postpartum women (n=114 total) received an ice pack between 2 and 48 h after delivery. The results showed that after 10 minutes of cryotherapy, the mean perineal temperature varied between 13.3°C and 15.3°C, with a small reduction at the end of the 15- and 20-minute applications (2.4°C and 2.7°C, respectively). Women who received cryotherapy for 10 minutes reported a cool sensation and pain relief; after a session of 15 or 20 minutes, the women reported anesthesia and numbness. In conclusion, an ice pack applied for 10 minutes reduced the perineal temperature to the recommended levels for analgesia (10-15°C).

Association between perineal trauma and pain in primiparous women

Objective To identify the association between perineal trauma and pain in 473 primiparous women. Method Cross-sectional study in which pain was measured by the numerical pain scale (0 to 10 - 0 being no pain and 10 maximal pain). Results The prevalence and mean intensity of pain were 33.0% and 4.7 points (standard deviation = 2.0) in the numeric scale, respectively. Episiotomy represented the most frequent trauma (46.7%). The occurrence and intensity of the pain were associated with perineal trauma and postpartum time. Having perineal trauma tripled the chance of pain. Each hour elapsed following the birth reduced the chance of pain by 4.8%. Conclusion Primiparous women are subject to a high frequency of perineal trauma, with episiotomy being the most prominent. Perineal pain affects approximately one-third of primiparous women and is associated with the postpartum time and perineal traumas.Objective To identify the association between perineal trauma and pain in 473 primiparous women. Method Cross-sectional study in which pain was measured by the numerical pain scale (0 to 10 - 0 being no pain and 10 maximal pain). Results The prevalence and mean intensity of pain were 33.0% and 4.7 points (standard deviation = 2.0) in the numeric scale, respectively. Episiotomy represented the most frequent trauma (46.7%). The occurrence and intensity of the pain were associated with perineal trauma and postpartum time. Having perineal trauma tripled the chance of pain. Each hour elapsed following the birth reduced the chance of pain by 4.8%. Conclusion Primiparous women are subject to a high frequency of perineal trauma, with episiotomy being the most prominent. Perineal pain affects approximately one-third of primiparous women and is associated with the postpartum time and perineal traumas.

Cryotherapy after childbirth: the length of application and changes in perineal temperature

We present a descriptive study based on the data from two clinical trials conducted at a maternity hospital in Sao Paulo, Brazil, in 2008 and 2009. This study aimed to describe perineal temperature after the application of an ice pack during the postpartum period. Three groups of 38 postpartum women (n=114 total) received an ice pack between 2 and 48 h after delivery. The results showed that after 10 minutes of cryotherapy, the mean perineal temperature varied between 13.3°C and 15.3°C, with a small reduction at the end of the 15- and 20-minute applications (2.4°C and 2.7°C, respectively). Women who received cryotherapy for 10 minutes reported a cool sensation and pain relief; after a session of 15 or 20 minutes, the women reported anesthesia and numbness. In conclusion, an ice pack applied for 10 minutes reduced the perineal temperature to the recommended levels for analgesia (10-15°C).

Evaluation and treatment of perineal pain in vaginal postpartum

Objectives: To identify the prevalence, intensity and therapeutic measures for relief of perineal pain in the vaginal postpartum. Methods: Cross-sectional study in a University Hospital Rooming Unit of the University of Sao Paulo; data were collected through interviews with 303 postpartum women who delivered vaginally (numeric scale from 0 to 10) to assess: perineal pain, perineal assessment and medical record data. Results: The prevalence of perineal pain was 18.5%, with moderate intensity (51.8%) associated with presence of episiotomy (p = 0.001). There were 303 vaginal deliveries, 80.5% had perineal trauma, episiotomy, 75.4% and 24.6% lacerations. The oral analgesic was the method used to relieve perineal pain. Conclusion: There are several treatments for perineal pain relief and there are no effective methods for complete resolution of the problem.

Effect of low-level laser therapy on pain and perineal healing after episiotomy: A triple-blind randomized controlled trial

Episiotomy is associated with perineal pain and healing complications. The low‐level laser therapy (LLLT) reduces pain and inflammation and stimulates the healing process. This study aimed to assess the effect of LLLT on pain and perineal healing after an episiotomy.

Episiotomy healing assessment: Redness, Oedema, Ecchymosis, Discharge, Approximation (REEDA) scale reliability

OBJETIVO: analizar la confiabilidad de la escala de Enrojecimiento, Edema, Equimosis, Drenaje, Aproximacion (REEDA) en la evaluacion de la curacion perineal tras parto normal con episiotomia mediolateral derecha. METODO: estudio observacional con base en datos de un ensayo clinico conducido con 54 mujeres elegidas de forma aleatoria, con evaluacion de su curacion perineal en cuatro momentos, entre 6 horas y 10 dias despues del parto, por enfermeras capacitadas en el uso de esta escala. El coeficiente de kappa fue utilizado en el analisis de confiabilidad de la escala REEDA. RESULTADOS: los resultados indican buena concordancia en la evaluacion del item drenaje (0,75< Kappa ≥0,88), concordancia marginal y buena en las primeras tres evaluaciones de edema (0,16< Kappa ≥0,46), concordancia marginal en la evaluacion de equimosis (0,25< Kappa ≥0,42) y buena concordancia sobre enrojecimiento (0,46< Kappa ≥0,66). Para el item coaptacion, la concordancia disminuyo de excelente en la primera evaluacion hasta buena en la ultima. En el cuarto momento, la evaluacion de todos los items mostro concordancia excelente o buena entre los evaluadores. CONCLUSION: la diferencia en las notas entre los evaluadores en la aplicacion de la escala indica que esta herramienta debe ser mejorada para permitir una evaluacion correcta del proceso de curacion de la episiotomiaOBJECTIVE: to analyse the Redness, Oedema, Ecchymosis, Discharge, Approximation (REEDA) scale reliability when evaluating perineal healing after a normal delivery with a right mediolateral episiotomy. METHOD: observational study based on data from a clinical trial conducted with 54 randomly selected women, who had their perineal healing assessed at four time points, from 6 hours to 10 days after delivery, by nurses trained in the use of this scale. The kappa coefficient was used in the reliability analysis of the REEDA scale. RESULTS: the results indicate good agreement in the evaluation of the discharge item (0.75< Kappa ≥0.88), marginal and good agreement in the first three assessments of oedema (0.16< Kappa ≥0.46), marginal agreement in the evaluation of ecchymosis (0.25< Kappa ≥0.42) and good agreement regarding redness (0.46< Kappa ≥0.66). For the item coaptation, the agreement decreased from excellent in the first assessment to good in the last assessment. In the fourth evaluation, the assessment of all items displayed excellent or good agreement among the evaluators. CONCLUSION: the difference in the scores among the evaluators when applying the scale indicates that this tool must be improved to allow an accurate assessment of the episiotomy healing process.OBJETIVO: analisar a confiabilidade da escala REEDA (Redness, Oedema, Ecchymosis, Discharge, Approximation) para avaliar a cicatrizacao do perineo apos parto vaginal com episiotomia medio-lateral direita. METODO: estudo observacional, baseado em dados coletados em ensaio clinico, conduzido com 54 mulheres, selecionadas aleatoriamente. As mesmas tiveram o processo de cicatrizacao perineal avaliado em quatro momentos (de 6 horas a 10 dias apos o parto), por enfermeiras treinadas para o uso da escala. O coeficiente kappa foi usado para analise de confiabilidade da escala REEDA. RESULTADOS: os resultados indicam bom nivel de concordância na avaliacao do item secrecao (0,75< Kappa ≥0,88), concordância boa e marginal em relacao ao item equimose (0,25< Kappa ≥0,42), e bom nivel de concordância em relacao a hiperemia (0,46< Kappa ≥0,66). O nivel de concordância referente a avaliacao do item coaptacao diminuiu de excelente, na primeira avaliacao, para bom, na ultima avaliacao. CONCLUSAO: a diferenca entre as pontuacoes atribuidas pelas avaliadoras na aplicacao da escala indica que o instrumento precisa ser melhorado, para permitir avaliacoes mais precisas do processo de cicatrizacao da episiotomia.

Ice pack induced perineal analgesia after spontaneous vaginal birth: Randomized controlled trial

BACKGROUND Ice-pack is widely used for alleviating postpartum perineal pain sustained after birth related perineal trauma. However, it lacks robust evidence on timing and frequency of applications, to ensure the effective and safe use of this therapy. AIMS To evaluate if a 10min ice-pack application relieved postpartum perineal pain and if the analgesic effect was maintained for up to 2h. METHODS A randomised controlled trial conducted from December 2012 to February 2013 with 69 primiparous women ≥18 years old, 6-24h postpartum, with perineal pain ≥3, who had not received anti-inflammatory medication or analgesics after childbirth, who were randomised to a single ice-pack application on the perineum for 10min or standard care. The primary and secondary outcomes were a reduction ≥30% in perineal pain intensity, immediately after the application and the maintenance of the analgesic effect for up to 2h, respectively. FINDINGS Immediately post-intervention, the proportion of women whose perineal pain decreased ≥30% was significantly higher in the experimental group. Within 2h, there was no significant difference in the pain levels in both groups. Within 2h, for 61.9% and 89.3% of women in the experimental and control group, respectively, the perineal pain levels remained unchanged. For the remaining participants, perineal pain was increasing after an average time of 1h 45min and 1h 56min for the experimental and control groups, respectively. CONCLUSION By applying an ice-pack for 10min to the perineum, effective pain relief is achieved, that is maintained for between 1h 45min and 2h.