Nonhealing Perineal Wounds: Current Strategies and Emerging Therapies

Perineal wound at the puerperium can be caused by episiotomy and lacerations during childbirth at the first labour or more. Factors that cause perineal lacerations are parity, birth spacing, breathing and pushing technique at giving birth, maternal age. fetal presentation and weight. The classification of wound healing perineum laceration is divided into 3 phases, firts is inflammatory phase (24 hours-48 hours), poliferation phase (48 hours-5 days), and the maturation phase (5 days and more). The purpose of this study was to analyze the factors associated with the healing time of perineal laceration wounds in puerperal mothers. This research method is quantitative with a cross sectional design of 34 respondents with total sampling techniques.This research was conducted at desember 2022-Januari 2023 at Singotrunuan Village, Subdistric Banyuwangi. Independent variables are patterns of nutritional fulfillment, personal hygiene, and early mobilization. The dependent variable is the healing of perineal laceration wounds. The collection data is using questionaire and analyzed using Chi Square statistical test. The results of the study found that there was a correlation between personal hyegiene, early mobilization, and nutritional fulfillment patterns with the duration of healing of perineal laceration wounds at the puerperal mother with p sig value of <0.005.It is hoped that this study can add insight and knowledge to postpartum mothers with perineal laceration wounds about factors that affect the healing time of perineal laceration wounds.

The female perineum becomes suffused and stretched during pregnancy, and further strain during vaginal childbirth contributes to approximately 85% of women experiencing some degree of trauma to the perineal region. Multiple factors play a role in the type and severity of trauma experienced, including parity, delivery method, and local practices. There is ongoing debate about best midwifery practice to reduce perineal trauma. Once perineal trauma has occurred, treatment also varies greatly, depending on its degree and severity, local practice and customs, and personal preference. In order to optimise wound-healing outcomes, it is important that wounds are assessed and managed in an appropriate and timely manner. A perineal wound may cause significant physical and/or psychological impact in the short or long term, however little evidence is available on this subject.Antenatal education serves to prepare women and their partners for pregnancy, delivery and the postpartum period. The delivery of this education varies widely in type, content, and nature. This review examined antenatal education which is specifically tailored towards perineal care and wound healing in the postnatal period via formal channels. Appropriate patient education positively impacts on wound-healing rates and compliance with wound care. Risk factors that contribute to the breakdown of wounds and poor healing rates may be addressed antenatally in order to optimise postnatal wound healing. It is important to assess whether or not antenatal wound-care education positively affects perineal healing, in order to empower women to incorporate best practice, evidence-based treatment with this important aspect of self-care in the immediate postnatal period. To evaluate the effects of antenatal education on perineal wound healing in postnatal women who have birthed in a hospital setting, and who have experienced a break in the skin of the perineum as a result of a tear or episiotomy, or both. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2017), ClinicalTrials.gov (8th September 2017), the WHO International Clinical Trials Registry Platform (ICTRP) (8th September 2017) and reference lists of retrieved studies. We considered randomised controlled trials (RCTs) which referred to all formal methods of antenatal education and addressed care of a potential perineal wound as a result of a tear or episiotomy, which was experienced by pregnant women who planned to give birth within a hospital setting.Trials using a cluster-RCT and a quasi-randomised design would have been eligible for inclusion in this review but none were identified. Cross-over trials were not eligible for inclusion in this review. Studies published in abstract form would have been eligible for inclusion in this review, but none were identified.We planned to consider all formal methods of antenatal education which addressed care of a perineal wound. We also planned to consider all contact points where there was an opportunity for formal education, including midwifery appointments, antenatal education classes, obstetrician appointments, general practitioner appointments and physiotherapist appointments. Two review authors independently assessed titles and abstracts of the studies identified by the search strategy for their eligibility. No studies met the inclusion criteria for this review. We excluded one study and one other study is ongoing. We set out to evaluate the RCT evidence pertaining to the impact of antenatal education on perineal wound healing in postnatal women who have birthed in a hospital setting, and who experienced a break in the skin of the perineum as a result of a tear or episiotomy, or both. However, no studies met the inclusion criteria. There is a lack of evidence concerning whether or not antenatal education relating to perineal wound healing in this cohort of women will change the outcome for these women in relation to wound healing, infection rate, re-attendance or re-admission to hospital, pain, health-related quality of life, maternal bonding, and negative emotional experiences. Further study is warranted in this area given the significant physical, psychological and economic impact of perineal wounds, and the large proportion of childbearing women who have experienced a postnatal wound. The benefits of any future research in this field would be maximised by incorporating women in a range of socio-economic groups, and with a range of healthcare options. This research could take both a qualitative and a quantitative approach and examine the outcomes identified in this review in order to assess fully the potential benefits of a tailored antenatal package, and to make recommendations for future practice. There is currently no evidence to inform practice in this regard.

Injuries after childbirth are one of the causes of labour infections among other causes. Factors that can accelerate wound healing include nutrition. Nutrition plays a role in helping the process of metabolism, maintenance and formation of new tissue. Egg whites contain more nutrients than egg yolks which can heal perineal suture wounds in mothers after childbirth. The study population was postpartum mothers with perineal suture wounds at Kramat Public Health Center on January 7-February 2, 2019. This study used a quasi-experimental design with the Pretest and Posttest With Control Group Design approach, where respondents divided into intervention groups and control groups of 20 respondents. The wound degree observed at the beginning of the observation and the rate of wound healing at the end. In the intervention group, the respondent required to eat five egg whites for six days. Data analysis was performed with ANOVA test (α: 5%; 95% Confident Interval) to see the effect of consumption patterns of chicken egg white with the level of wound healing perineum. The results showed an influence of consumption patterns of boiled chicken egg white on the rate of perineal suture wounds healing as indicated by the higher number of respondents with a reasonable wound healing rate in the intervention group of 62.5% (5 people) compared to the control group, which was 42.9% (3 people) and from the Anova test results obtained a p-value of 0.015. Thus it is recommended that postpartum mothers consume many egg whites in order to accelerate the healing of perineal wounds to prevent infections due to perineal wounds . Keywords: Egg white, Perineal suture wounds Healing

Fetal breeching presentation is position of fetus with his bottom-first in the maternal’s uterus. It will increase risk of perinatal or neonatal mortality and morbidity, if breech presentation persisted at term. During labor, a woman could experienced perineal tears wound due to the impact of contraction pressure on intact perineum – especially for primiparous woman and heavier birth weight – as well as to episiotomy. The degree of perineal tears wound are classified as the first and second grade which are being considered as at low risk of infection and there is no indication of prophylactic antiobiotics; while the third and fourth degree perineal trauma are compulsory to be given antibiotics due to the higher risk of infection. This is cases of two multiparous women whose maternal status during antenatal care presented at Puskesmas – a pirmary healthcare facility in Indonesia – one patient with breech position at weeks 29- 34 and the other one was on chonic energy deficiency who were constantly in low blood pressure (BP) of 100/60 mmHg, MAP 73,3 mmHg, and poor nutritional state. The patients came from low social-economic and education. Healthcare team at Puskesmas provided childbirth education including perineal tears wound care, and pharmacist served medication literacy assistance due to lack of knowledge about their medication administration. This pharmacist’s assistance was delivered on hybrid system due to Covid-19 pandemic. The patient managed to deliver the baby on vaginal birth with second degree perineal tears and started on antibiotics, analgesics, vitamin A, and iron tablets. One of the patient presented with fever, BP of 90/60 mmHg, and wound infection on day-3 postpartum; thus received another cure of antibotics and analgesic. The patients’ knowledge were improved, drug compliance were 100%, perineal tears wound care had been done properly, so that the wound completely dried and healed on day-42 postpartum. Keywords: antibiotics, high risk, perineal wound, knowledge, behaviour.

Perineal wounds are tears that occur during childbirth, either spontaneously or with the use of instruments or procedures. Proper care of perineal tissue wounds is essential to prevent infection. Protein intake greatly influences the healing process of perineal wounds. The nutritional content of eggs includes more than 90% calcium and iron; one egg contains 6 grams of high-quality protein and 9 essential amino acids. High-protein foods can be obtained from chicken eggs, which contain 12.58 grams of protein. Poor wound care can lead to complications such as urinary tract infections or genital tract infections. The purpose of this study was to determine whether boiled chicken egg consumption has an effect on perineal wound healing in postpartum mothers. This study used a true experimental design with a two-group posttest-only method. The population consisted of 47, with a total sample of 20 postpartum mothers with second-degree perineal wounds, selected through purposive sampling. The study was conducted over 7 days. Data analysis used the Mann-Whitney U Test because the data distribution was not normal. The results showed a p-value = 0.002 (p < 0.05), indicating a significant difference in perineal wound healing time between the intervention and control groups. The effectiveness of chicken eggs, which contain high-quality protein and essential amino acids, can accelerate tissue repair within 7 days. In conclusion, the frequency distribution of perineal wound healing after consuming boiled eggs shows an accelerated healing process, with wounds drying faster, stitches closing more quickly, and pain decreasing compared to the group that did not consume boiled eggs.Keywords: Perineal Wounds, Postpartum, Protein, Chicken Eggs

Perineal wounds are injuries to the urogenital diaphragm and anal muscle during vaginal delivery, either normal delivery or instrumental delivery. Knowledge is a very important domain for the formation of a person's attitudes and behavior. The aim of the research was to determine the relationship between maternal knowledge, attitudes and behavior regarding perineal suture wound care and the healing time for perineal suture wounds. This type of quantitative research with a cross sectional design. The research was conducted in June-July 2023. The research population was postpartum mothers with perineal wounds in June-July 2023. The total was 30 people. The population in this study was 30 people. The sampling technique is the total sampling population. The research results obtained from 30 respondents showed that there were 22 mothers who had good knowledge (73.3%), 22 mothers who had a positive attitude (73.3%), 23 mothers who had good behavior (76%). .7%). The results of the Chi-Square analysis test for the knowledge category obtained a p value = 0.002 (p = <0.05), for the attitude category the p value = 0.002 < (0.05) while for behavior the p value = 0.001 < (0). .05). The conclusion is that there is a relationship between knowledge, attitudes and behavior regarding perineal wound care and the healing time for perineal wound sutures in the work area of the UPTD Campaka Community Health Center in 2023. The suggestion is that postpartum mothers should improve their behavior regarding wound care as an effort to speed up the healing of perineal wounds.

Background: The postpartum period is a time for the restoration of the reproductive organs to their pre-pregnancy condition. One of the problems that often occurs in postpartum mothers is perineal rupture. Betel leaves are known to have chemical content that acts as an antiseptic and antibacterial drug, in addition betel leaves also contain chemicals as anti-inflammatories that are good for mothers who experience perineal wounds, which can help accelerate perineal wound healing. Objectives: This study aimed to apply the administration of boiled betel leaves to postpartum women with second-degree perineal tears at the Rancaekek DTP Health Center. Method: Systematic searching was conducted to find the best literature before implementing the intervention. The intervention was given to Mrs. R P3A0 postpartum with a second-degree perineal suture wound. The formula given was 25 grams of betel leaves added to 100 ml of water and boiled for 15 minutes. Then filtered and the boiled water was used to clean the vulva in the morning and evening. Perineal wound healing was evaluated daily using the REEDA questionnaire. Results: The results of the first day's evaluation obtained a REEDA score of 9, day 2 score 4, day 3 score 3, and day 4 REEDA score 0 which means the wound healed. Thus, the healing of the perineal wound in Mrs. R took place in 4 days.. Betel leaf decoction is effective in accelerating the healing of stitches in Mrs. R. Conclusion: The use of betel leaves decoction can be used as an effective alternative for perineal wound care.

The incidence of wound infection and dehiscence following childbirth-related perineal trauma: A systematic review of the evidence

Background Patients with inflammatory bowel disease (IBD) may need to undergo proctectomy or ileal pouch-anal anastomosis (IPAA) extirpation with known short- and long-term perineal complications such as wound dehiscence, delayed healing, sinus formation and fistulas. This study aimed to examine perineal complications after proctectomy or IPAA extirpation. Methods This Swedish retrospective, multicentre study included IBD patients ≥18 years undergoing proctectomy or IPAA-extirpation between January 1st 2000 and December 31st 2019 at four hospitals. Medical records were reviewed and perineal wound healing was assessed at 3, 6, 12 and 24 months. Primary endpoint was need for perineal re-operation due to complications. Predefined factors associated with reoperation was assessed. Results Four hundred and fifty-one patients (257 males) were included in the study. After 3, 6, 12 and 24 months 70%, 75%, 80% and 88% had healed. Forty-nine (11%) patients underwent re-operation for perineal wound complication. Low age and short duration of IBD were significantly associated with the risk of reoperation (p<0.001 and p=0.032). Crohn′s disease was more common (55%) in the group that underwent re-operation compared to 41% in the no-reoperation group but not statistically significant (p=0.06). Most patients that underwent re-operation demonstrated a wound complication or perineal wound secretion within 30 days of surgery; 90% vs 48% ;p<0.001[KL1] and 80% vs 37%; p<0.001 [KL2] respectively. Following re-operation, the perineal wound healed in 45% (22/49). Conclusion At long-term follow-up 88% had healed perineal wound and only 11% had required perineal reoperation. Wound complications and secretion within 30 days of surgery seem unfavourable and predict reoperation and incomplete perineal healing.

Many factors influence the healing of perineal wounds such as internal, external to the mother and factors from health workers. Healing efforts can be carried out by non-pharmacological methods, namely Kegel exercises, mobilization, herbal concoctions. Healing perineal wounds from the perspective of health workers such as suturing techniques. There are several techniques for sewing perineal wounds, such as interrupted, continuous, subticular. The purpose of this study was to see differences in the healing of perineal wounds in postpartum mothers using the interrupted technique and the subticular technique at the T and BPM D Clinics in Deli Serdang Regency in 2020. The design of this study was an experiment with a longitudinal time approach. Sample: All postpartum women who experienced perineal injuries at the Second Grade clinic at T and BPM D Clinics were 20 people. Results: The average perineal wound healing using the basting technique was faster healing (15.20) than the dotted technique (17.40) . The results of the bivariate analysis stated that there was no significant difference between the healing time of the perineal hecting wound with the dotted technique and basting with a value of p = 0.271 (> 0.005). Health workers should improve their ability to handle episiotomy wounds so that they heal quickly and do not get infected

Perineal tears are a good medium for germs to breed if they don't get proper care. This is also one of the causes of the variation in healing time for perineal wounds. Long wound healing time and inappropriate care techniques can result in postpartum infections. Non-pharmacological therapy that can be given to speed up healing includes the intervention of snakehead fish and catfish therapy. To determine the difference in the effectiveness of providing snakehead fish and catfish therapy in healing perineal wounds in postpartum mothers in the working area of the Majalaya health center. This research is a type of quantitative research. In this research, the Quasy Experiment design method was used with a Pretest and Posttest Nonequivalent Control Group research design. The population in this study was the target postpartum mothers with perineal rupture wounds in the working area of the Majalaya health center who gave birth at the end of June 2024, totaling 30 postpartum mothers. The research sampling technique used total sampling. The samples in this study were postpartum mothers who were in the working area of the Majalaya health center who gave birth with a history of 1st and 2nd degree perineal lacerations in June 2024, 15 postpartum mothers who received snakehead fish therapy intervention and 15 postpartum mothers who received catfish therapy intervention. 15 postpartum mothers. The results of the different tests were carried out using the independent T test on the post-test data for the Snakehead Fish Intervention and Catfish Intervention groups with a p-value = 0.000, which means <0.05. So it can be concluded that there are differences regarding the effect of providing snakehead fish and catfish intervention therapy on the level of healing of perineal wounds in postpartum mothers in the working area of the Majalaya Health Center. There is a significant difference between giving snakehead fish therapy and catfish therapy in healing perineal wounds. Snakehead fish therapy is more effective in healing perineal wounds in postpartum mothers compared to giving catfish therapy (p value 0.00 < 0.05). Keywords: Snakehead Fish Therapy, Catfish Therapy, Perineal Wounds, Postpartum Mothers

Perineal wound healing is a significant challenge after extralevator abdominoperineal excision (ELAPE) due to a high rate of wound breakdown. Negative pressure therapy has proven benefits in open wounds, and recently a negative pressure system has been developed for use on closed wounds at high risk of breakdown, such as apronectomy and hysterectomy. The aim of the present study was to determine whether negative pressure therapy applied to closed perineal wounds after ELAPE improved wound healing and compare outcomes to the published literature and outcomes from a historical cohort of patients who had undergone 'standard' abdominoperineal resection (APR) and primary closure of the perineal wounds. Prospective data on consecutive patients having ELAPE in the period from November 2012 to April 2015 were collected. The pelvic floor defect was reconstructed with biologic mesh. The adipose tissue layer was closed with vicryl sutures, a suction drain was left in the deep layer, the subcuticular layer and skin were closed, and the negative pressure system was applied. Any wound breakdown within the first 30 days postoperatively was recorded. Of the 32 consecutive ELAPE patients whose perineal wounds were closed within 30days with the use of the negative pressure system, there was 1 patient with major perineal wound breakdown and 2 patients with a 1cm superficial wound defect, which needed no further treatment. In the remaining 29 (90%) patients, the perineal wounds healed fully without complications. Twenty-five patients underwent standard APR in 2010-2011 with primary closure of their perineal wounds. Ten out of 25(40%) of patients who had undergone standard APR and primary closure of perineal wounds had major wound complications (p=0.01). Our results suggest that after ELAPE the application of a negative pressure system to the perineal wound closed with biologic mesh may reduce perineal wound complications and may reduce the need for major perineal reconstruction.

Perineal pain arises due to tearing or laceration of the perineum during the birth process due to severed tissue, which stimulates the hypothalamus to release pain receptors in the perineal area. Caring for perineal wounds, one of the important things is carrying out vulva hygiene. The benefits of vulva hygiene are keeping the vagina and the surrounding area clean and comfortable, preventing the appearance of vaginal discharge, unpleasant odors and itching and maintaining a constant vaginal pH. Vulva care is carried out every morning and evening before bathing, after urinating, defecating and if the postpartum mother feels uncomfortable because the lochea smells or there are complaints of pain. As a result of poor perineal wound care, the condition of the perineum affected by lochea becomes moist and will greatly support the growth of bacteria which causes infection in the perineum which can hinder the wound healing process. The postpartum period is an important thing to pay attention to, where the recovery of reproductive organs that experience changes during the pregnancy process occurs. Knowing the Factors Associated with the Healing of Perineal Suture Wounds in Postpartum Women at the Ujungpandang Baru Community Health Center. This study used a descriptive method. Mobilization and personal hygiene factors were related to perineal suture wound healing and tradition was not related to perineal suture wound healing.

Postpartum infection is likely to originate from infected perineal suture wounds. These suture wounds are caused by episiotomy or infected incisions and due to tears in the birth canal or perineal tears. This study aims to determine the Effect of Green Betel Leaf Boiled Water in Accelerating Perineal Wound Healing at the Beutong Ateuh Health Center, Beutong Ateuh Banggalang District, Nagan Raya Regency, Aceh Province in 2024. This type of research is a quasi-experimental research method with a Post test with control group design. The population is all postpartum mothers who experience grade I-II perineal wounds at the Beutong Ateuh Health Center, Beutong Ateuh Banggalang District, Nagan Raya Regency, Aceh Province, as many as 22 people. The number of samples used was 22 people obtained using the Total sampling technique. The data analysis technique used the paired sample t-test value. The results obtained in this study were from 22 respondents, there was a difference in the effect of green betel leaf decoction in accelerating the healing of perineal wounds in the intervention group and the control group with the independent sample t test obtained results for the value of p = 0.000 meaning p <0.05.

Caring for perineal wounds in mothers after giving birth is useful for reducing discomfort, maintaining cleanliness, preventing infection and speeding up the healing of perineal suture wounds. The aim of the research was to determine the effectiveness of boiled red betel leaves for healing perineal wounds in the Panipahan Community Health Center Working Area, Pasir Limau Kapas District, Rokan Hilir Regency. The type of research is quantitative and quasi-experimental design with one group pretest-posttest. The population is postpartum mothers and the sample is 12 people, with purposive sampling. The research instruments were observation sheets and boiled red betel leaves. Data analysis uses univariate and bivariate. The univariate results show that the average maternal wound healing score on the first postpartum day as assessed by REEDA before red betel leaf decoction therapy was 7.14 and after red betel leaf decoction therapy the score decreased to 0.35. The results of the paired sample t test obtained a p-value of 0.000 < 0.05. The conclusion is that red betel leaf decoction is effective for healing perineal wounds in the Panipahan Health Center Working Area. It is hoped that the Panipahan Community Health Center can improve services, especially in the field of postpartum maternal care, to accelerate wound healing by providing education and counseling about the importance of using boiled red betel leaves.Keywords: Red Betel Leaves, Perineal Wounds