INTRODUCTION: Interventions aimed at perineal healing and pain relief can have a positive impact on postpartum experiences in women who experience perineal trauma during childbirth.
OBJECTIVE: The aim of this systematic review and meta-analysis was to compare various methods applied for healing and pain relief from perineal trauma based on primary studies.
METHODS: The study protocol was developed following PRISMA guidelines, and Meta-Analyses guidelines. Searches were conducted between March and April 2024. Registration was completed using PROSPERO. Searches were performed using PubMed, the Cochrane Library, EBSCO, Embase, Web of Science, PsycINFO, Scopus, National Thesis Center, TR Dizin, Türkiye Klinikleri, and DergiPark Academic search engines. The methodological quality of the studies was assessed using the RoB-1 and RoB-2. Data were aggregated through meta-analysis, and a GRADE evidence profile was created.
RESULTS: Nineteen studies involving 1899 participants were included in the meta-analysis. The results showed that interventions performed within the first 24 h after episiotomy did not reduce pain. However, the effects of the interventions were observed on the second day, with cold application identified as the most effective method. Additionally, interventions did not affect healing during the first three days, but a more pronounced improvement was noted in the intervention group by the fifth day. Healing began around the 7th-10th days even without intervention. The REEDA (redness, edema, ecchymosis, discharge, and approximation) score decreased most significantly in the group that received perineal education (diet, Kegel exercise, infection symptoms, and perineal hygiene).
CONCLUSION: Cold application is recommended on the second day to reduce pain following perineal trauma. Interventions were found to accelerate the healing process by initiating healing at least two days earlier, with perineal education being the most effective method. However, further research on topical herbal treatments and perineal hygiene education is needed to strengthen this evidence.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
This SR has some major limitations from a methodology standpoint (e.g., exclusion of some studies based on assessment of low quality, lack of full geographic diversity, lack of subgroup analysis by parity or by whether wound was secondary to episiotomy or not, degree of wound, likely violation of fundamental assumptions of meta-analysis and network meta-analysis). I would not rely on it to fully inform practice.
Physician rater
For the pain outcomes, I am dubious about the low "risk of bias" scores in outcome assessments since most of the interventions were not blinded. Placebo effects are strong. Similar bias may have played a role in the assessment of healing outcomes. These biases can be subtle and pervasive. Still, the meta-analysis provides a useful overview of the types of studies that investigators have been pursuing.
, McMaster University