Abstract
OBJECTIVE: 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.
Highlights
IntroductionEpisiotomy, a common procedure in obstetric care, is associated with the need for suture and healing complications in the postpartum period, such as blood loss, oedema, haematoma, infection wound dehiscence and perineal pain[1]
Episiotomy, a common procedure in obstetric care, is associated with the need for suture and healing complications in the postpartum period, such as blood loss, oedema, haematoma, infection wound dehiscence and perineal pain[1].Inflammatory signs, such as oedema, ecchymosis, redness and pain, occur from the first hours after delivery and may remain beyond the hospitalization period
The aim of this study is to analyse the reliability of the scale REEDA as a tool for the clinical assessment of perineal healing after episiotomy
Summary
Episiotomy, a common procedure in obstetric care, is associated with the need for suture and healing complications in the postpartum period, such as blood loss, oedema, haematoma, infection wound dehiscence and perineal pain[1]. Inflammatory signs, such as oedema, ecchymosis, redness and pain, occur from the first hours after delivery and may remain beyond the hospitalization period. A randomized controlled trial which compared two different perineal repair techniques identified that oedema, redness and ecchymosis occurred in 26.2%, 6.6% e 3.3% of women who had episiotomy or second degree laceration at the first 24 hours after childbirth, respectively. Fundal pressure, guided pushing, birth weight, perineal management manoeuvres during labour and suture material and technique might influence postpartum perineal pain, as these parameters influence the rates and severity of spontaneous perineal trauma and episiotomies[4,5]
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