Episiotomy Wound Care, Episiotomy Wound Healing and Pain Perception

Study Overview
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Brief Summary
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The World Health Organization (WHO) and professional societies recommend restricted episiotomy instead of routine episiotomy. However, since the 1990s, there has been evidence of the risks of the procedure, and although routine use has no benefit, it is still widely used. In this study, investigators aimed to determine the effect of episiotomy on the wound healing process and pain perception by providing episiotomy wound healing and genital hygiene training with training material created to raise awareness about wound care after episiotomy and to eliminate factors that delay the healing of episiotomy wound.

Detailed Description
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This study aimed to determine the effect of episiotomy wound care and genital hygiene training on episiotomy wound healing and pain perception. Methods: In this study, investigators used a randomized controlled trial approach. It was carried out in the postpartum service of the medical faculty hospital. 128 participants who underlap vaginal postpartum episiotomy were randomly assigned to the experimental and control group. The women who gave birth in the experimental group were given episiotomy wound care and genital hygiene training. The routine postpartum care was given to the participants who gave birth in the control group. The data were collected using the personal information form, the episiotomy area evaluation scale (REEDA score), and the Visual Analog Scale (VAS). .

Official Title
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The Effect of Episiotomy Wound Care and Genital Hygiene Training on Episiotomy Wound Healing and Pain Perception: Randomized Controlled Trial

Conditions
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Episiotomy Wound, Wound Healing, Pain, Training, Toilet

Intervention / Treatment
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* Other: Episiotomy Wound Care and Genital Hygiene Training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18 years of age and older primiparous givingbirth vaginally on due date (37-42 gestational weeks) who have a healthy newborn, who have a mediolateral episiotomy, who do not have communication problems who can understand and speak Turkish were included in the research. Exclusion Criteria: Givingbirth by cesarean section Having third and fourth-degree perineal tears, Having a history of diseases that prevent wound healing, Using certain drugs (eg, glucocorticoids, anticoagulants, chemotherapy, immunosuppressant, and radiotherapy), Having chronic systemic diseases (heart, kidney and lung diseases, coagulation disorder, immunodeficiency, connective tissue disorders, and diabetes), Having history of genital warts, symptomatic vaginitis, Having history of perineal reconstructive surgery, any postpartum complication (hemorrhage, puerperal infection, mastitis, thromboembolic disease or postpartum psychiatric disorder)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: The research is an experimental study with parallel groups including randomized controlled, experimental, and control with educational intervention
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: training + written and illustrated training brochure<br>Postpartum first day was given wound care and genital hygiene training (one hour). At the end of the training, the mothers were given a written and illustrated training brochure. | Other: Episiotomy Wound Care and Genital Hygiene Training<br>* Episiotomy wound healing and genital hygiene training were given face-to-face by researchers to the mothers assigned to the training group. The trainings were given to each mother individually in their rooms. The total training lasted an average of one hour. At the end of the training, the mothers were given a written and illustrated training brochure. Training content Primarily, external reproductive organs were shown to mothers through pictures. Urethra, Vagina, Anus, Perineum areas were mentioned. The definition of Episiotomy was made; and where and how it was applied was explained with visual materials. It was explained how to care for the episiotomy area to heal more rapid and healthier. Information was given on how to change their menstrual pads. Information was provided on what to look for when using underwear What to watch out while taking a bath: What to pay attention to in your stitch area<br>|
| No Intervention: Standard of care (Control group)<br>Standard of care (Control group) Left to the usual care of the hospital | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Personal information form before intervention | Assessed using personal information. This instrument contains questions on women's sociodemographic and postpartum. | postpartum 1sth day (after birth first 24 hours) | 
| Episiotomy Area Evaluation before intervention | Assessed using the Episiotomy Area Evaluation Scale (REEDA SCORE) before intervention. This scale covers five factors indicating perineal wound healing: (1) Redness, (2) Edema, (3) Ecchymosis, (4) Discharge, and (5) Approximation. A total REEDA score is obtained by evaluating each category of these five recovery factors. The scale is evaluated by giving 0, 1, 2, and 3 points to each evaluation. The lowest score is 0 and the highest score is 15. | postpartum 1sth day (after birth first 24 hours) | 
| Episiotomy pain Evaluation before intervention | The Visual Analogue Scale (VAS) scale, which would be applied to evaluate episiotomy pain in the postpartum period, was used to convert some values that cannot be measured numerically, and two-end definitions of the parameter to be evaluated are written at both ends of a 100 mm line. The participant was asked to indicate where his or her condition is suitable on this line by drawing a line or by placing a dot or pointing. No pain is written on one end and very severe pain on the opposite end; the participant was asked to mark the pain condition on this line.was used to convert some values that could not be measured numerically, and two-end definitions of the parameter to be evaluated are written at both ends of a 100 mm line. | postpartum 1sth day (after birth first 24 hours) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Episiotomy Area Evaluation after intervention | Assessed using the Episiotomy Area Evaluation Scale (REEDA SCORE) before intervention. This scale covers five factors indicating perineal wound healing: (1) Redness, (2) Edema, (3) Ecchymosis, (4) Discharge, and (5) Approximation. A total REEDA score is obtained by evaluating each category of these five recovery factors. The scale is evaluated by giving 0, 1, 2, and 3 points to each evaluation. The lowest score is 0 and the highest score is 15. | postpartum 5th day | 
| Episiotomy pain Evaluation after intervention | The Visual Analogue Scale (VAS) scale, which would be applied to evaluate episiotomy pain in the postpartum period, was used to convert some values that cannot be measured numerically, and two-end definitions of the parameter to be evaluated are written at both ends of a 100 mm line. The participant was asked to indicate where his or her condition is suitable on this line by drawing a line or by placing a dot or pointing. No pain is written on one end and very severe pain on the opposite end; the participant was asked to mark the pain condition on this line.was used to convert some values that could not be measured numerically, and two-end definitions of the parameter to be evaluated are written at both ends of a 100 mm line. | postpartum 5th day | 
| Episiotomy Area Evaluation after intervention | Assessed using the Episiotomy Area Evaluation Scale (REEDA SCORE) before intervention. This scale covers five factors indicating perineal wound healing: (1) Redness, (2) Edema, (3) Ecchymosis, (4) Discharge, and (5) Approximation. A total REEDA score is obtained by evaluating each category of these five recovery factors. The scale is evaluated by giving 0, 1, 2, and 3 points to each evaluation. The lowest score is 0 and the highest score is 15. | Postpartum 15th day | 
| Episiotomy pain Evaluation after intervention | The Visual Analogue Scale (VAS) scale, which would be applied to evaluate episiotomy pain in the postpartum period, was used to convert some values that cannot be measured numerically, and two-end definitions of the parameter to be evaluated are written at both ends of a 100 mm line. The participant was asked to indicate where his or her condition is suitable on this line by drawing a line or by placing a dot or pointing. No pain is written on one end and very severe pain on the opposite end; the participant was asked to mark the pain condition on this line.was used to convert some values that could not be measured numerically, and two-end definitions of the parameter to be evaluated are written at both ends of a 100 mm line. | Postpartum 15th day | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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wound healing, Episiotomy, genital hygiene, postpartum care, REEDA scale