Perineal Wound Research Articles

Evaluation of Comprehensive Documentation After Obstetric Anal Sphincter Injury.

The incidence of obstetric anal sphincter injuries (OASI) has increased in recent years, which may be due to improved recognition and documentation. There is limited evidence regarding the effects of thorough documentation of obstetric anal sphincter injury repairs on postpartum clinical outcomes. Our objectives were to (1) compare the incidence of perineal wound complications between documentation groups, (2) compare other adverse events, and (3) to describe factors associated with adequate documentation. We hypothesized that better documentation would be associated with improved clinical outcomes. This was a retrospective cohort study of 599 patients with OASI at a tertiary care referral center between January 2015 and December 2020. A priori definitions of documentation adequacy were utilized to stratify delivery notes. On the basis of these criteria, there were preferred, adequate, and inadequate documentation groups. Maternal characteristics, outcomes, and peripartum factors were compared between the groups. There were no significant differences in clinical outcomes between the groups. A higher degree of perineal laceration (p < 0.001), greater blood loss (p = 0.002), and the need for repairs in the operating room (p = 0.019) were significant factors associated with adequate documentation. Clinicians who were comprehensive in their documentation were more likely to refer patients to Urogynecology (p < 0.001) and to add OASI to the electronic medical record problem list (p = 0.005). While certain factors are associated with adequate documentation, this did not improve clinical outcomes for OASI and further research is warranted to explore the importance of medical documentation surrounding OASI.

Benefits of Betel Leaves as a Medicine for Postpartum Perineal Wounds

Indonesia is a country rich in natural materials for human health. One of them is red betel. This research was conducted to formulate red betel as a medicine for perineal wounds in mothers after childbirth. Making wound medicine by boiling. Boil 4-5 sheets or 9-11 grams (Piper Crocatum) that have been washed thoroughly, put 500 ml of water into a pot made of clay so as not to damage the substance content of red betel leaf (Piper Crocatum). Wait for it to boil for 15 minutes. Let the boiled water cool for 30 minutes, then strain the water and put the filtered result in the sterile bottle that has been provided. After that, respondents will use boiled water with red betel leaves (Piper Crocatum) after taking a shower in the morning and also in the afternoon. After finishing, the respondent will dry his female intimate organs with a towel until dry. Rinse the boiled water of red betel leaves (Piper Crocatum) once a scoop is given as much as 200 ml for one use.

TOpClass Class 4 Perineal Crohn's Disease: A Systematic Review and Meta-analysis of Perineal Wound Complication After Proctectomy in Crohn's Patients.

Nonhealing perineal wounds have been reported to be common after proctectomy for Crohn's disease (CD). We performed a systematic review and meta-analysis of perineal wound healing after proctectomy for CD and assessed the risk factors for nonhealing. A comprehensive literature search was conducted in PubMed, Embase, and Scopus databases from 2010 to 2023, and articles reporting perineal wound healing rates after proctectomy for CD were included. Data on study characteristics and proportion of healed wounds, and risk factors, were extracted. Random-effects meta-analysis was performed to estimate the pooled proportion and 95% CIs using the "meta" package in R. Heterogeneity was assessed using the I2 statistic. We identified 501 articles, of which 252 remained after de-duplication. After screening, 4 retrospective cohort studies involving 333 patients were included. Across the 4 studies, the pooled proportion of completely healed perineal wounds at 6 months was 65% (95% CI 52%-80%), and 70% (95% CI 60%-83%) at 12 months. Significant heterogeneity was found between studies (I2 = 86% at 6 months). Three studies examined risk factors for impaired healing after proctectomy. One study identified preoperative perineal sepsis as the only independent factor associated with impaired healing (P = .001) on multivariable analysis. In 1 study, male sex, shorter time from diversion to proctectomy, and higher preoperative C-reactive protein levels were all associated with delayed healing in univariate analysis. Another study found that close rectal dissection was associated with significantly lower healing rates than total mesorectal excision (P = .01). Prior use of tumor necrosis factor inhibitors was not associated with wound healing outcomes. This meta-analysis revealed complete perineal healing in only 70% of patients 12 months after proctectomy for CD. This highlights knowledge gaps, including the identification of modifiable risk factors and methods for preventing or as rescue therapy, such as vacuum-assisted closure and flap reconstruction, for nonhealing perineal wounds after proctectomy for CD. Poor perineal wound healing outcomes are likely related to imperfectly understood underlying inflammatory dysregulation and systemically impaired wound healing in patients with CD.

Transperineal minimally invasive surgery during laparoscopic abdominoperineal resection for low rectal cancer could improve short-term outcomes: A single-institution retrospective cohort study.

Transperineal minimally invasive surgery (TpMIS) during laparoscopic abdominoperineal resection (APR) is an emerging approach that allows for the precise treatment of lower rectal cancer. However, evidence regarding the efficacy of TpMIS is insufficient. This study evaluated the efficacy of TpMIS during laparoscopic APR for patients with lower rectal cancer. Patients who underwent laparoscopic APR with TpMIS (TpMIS group; n = 12) and those who underwent conventional laparoscopic APR for low rectal cancer (conventional group; n = 13) were enrolled consecutively in this retrospective study. Standardized TpMIS was performed at our institution. Patient and tumor characteristics and intraoperative, postoperative, and pathological outcomes were compared between groups. The primary outcome was postoperative perineal wound infection. No patients in the TpMIS group experienced postoperative perineal wound infection; however, five (38.5%) patients in the conventional group experienced postoperative perineal wound infection (significant difference; p = 0.016). The estimated blood loss (median, 81mL vs. 463mL) and incidence of postoperative urinary dysfunction (8.3% vs. 46.1%) were significantly lower in the TpMIS group than in the conventional group. The postoperative hospital stay (median, 13 vs. 20days) of the TpMIS group was significantly shorter than that of the conventional group. Pathological outcomes did not differ between groups. The positive circumferential resection margin rates of the TpMIS and conventional groups were 8.3% and 15.4%, respectively. TpMIS during laparoscopic APR was associated with significant improvements in the postoperative outcomes of patients with low rectal cancer.

Effect of Static Contraction on The Rate of Healing of Perineal Wounds in Postpartum Mothers with Perineal Tears

Effect of Static Contraction on The Rate of Healing of Perineal Wounds in Postpartum Mothers with Perineal Tears

Effectiveness of Centella Asiatica (Pegagan) Spray Gel on Perineal Wound Healing in Postpartum Women

Perineal wounds in postpartum mothers can potentially cause infections. The perineal area exposed to lochia and moisture creates an environment conducive to bacterial growth, thus hindering the wound healing process. Infections of perineal wounds can involve various types of bacteria that naturally colonize the skin and genital mucosa. The application of centella asiatica spray gel is one of the non-pharmacological methods for healing perineal wounds in postpartum mothers. This study aims to determine the effectiveness of applying centella asiatica spray gel 3 times a day with a concentration of 25% for 7 days on perineal wound healing and the growth of Staphylococcus aureus bacteria in postpartum mothers. This is a True Experimental study with a pretest–posttest control group design. Based on the inclusion criteria of second-degree perineal wounds with sutures were selected using random sampling, 17 participants to receive centella asiatica spray gel and 17 participants received standard dry-clean care. The level of wound healing was measured using the REEDA score. The growth of Staphylococcus aureus bacteria was measured using a colony counter. REEDA score data were analyzed using the Friedman and Mann-Whitney tests, while Staphylococcus aureus growth was analyzed using the Wilcoxon and Mann-Whitney tests. Based on the average decrease in REEDA scores by 1.06, the application of centella asiatica spray gel was effective for perineal wound healing (p=0.000). There was a significant difference in the average growth of S.aureus (p=0.040) in perineal wounds of postpartum mothers, with the intervention group showing an average difference of 6.34. The application of centella asiatica spray gel 3 times a day with a concentration of 25% for 7 days was effective for perineal wound healing and reducing Staphylococcus aureus growth in postpartum mothers.

Efektivitas Rebus Daun Sirih Merah dan Konsumsi Telur Ayam Rebus terhadap Luka Perineum pada Ibu Postpartum di PMB S Kabupaten Pandeglang Tahun 2024

Poor care of perineal wounds can cause infection which will slow down the healing process of perineal wounds. Efforts to prevent perineal wound infections can be provided with pharmacological therapy and non-pharmacological therapy. To provide midwifery care and determine the effectiveness of boiling red betel leaves and consuming boiled chicken eggs on perineal wounds in postpartum mothers. The research used is descriptive qualitative research. The target of the activity was 2 postpartum mothers who had perineal wounds who were given intervention 1 by giving boiled red betel leaves, and intervention 2 by giving boiled chicken eggs for 5 days. From the research results, it was found that postpartum mothers who experienced perineal wounds before and after being given intervention experienced accelerated healing of perineal wounds on the 4th day. There is an effect of boiled red betel leaves and boiled chicken eggs on accelerating the healing of perineal wounds in postpartum mothers. For postpartum mothers, consume boiled chicken eggs and red betel leaves to speed up the healing of perineal wounds.

PENGARUH SPRAY GEL EKSTRAK BATANG BAJAKAH TAMPALA (SPATHOLOBUS LITTORALIS HASSK) TERHADAP PENYEMBUHAN LUKA PERINEUM PADA IBU NIFAS

Perineal laceration occurred during childbirth, either naturally or through episiotomy. One alternative for perineal wound healing was using a spray gel of Bajakah tampala stem extract, which had anti-inflammatory, antioxidant, and antibacterial benefits that helped accelerate perineal wound healing. The spray technique delivered the preparation directly to the wound without contact with cotton, reducing waste and preventing infection or contamination. This study aimed to determine the effect of Bajakah tampala stem extract spray gel (Spatholobus littoralis Hassk.) on perineal wound healing in postpartum women. The study was conducted at the Eka Setyowati midwife practice and Ngesrep Health Center from January to February 2024. It was a quasi-experiment with a pretest and posttest control group design. Using purposive sampling, 36 respondents were obtained and divided into two groups: the control group, which received dry clean wound care, and the intervention group, which was given Bajakah tampala stem extract spray gel three times a day for seven days with three sprays per application. The perineal wounds were measured using the REEDA scale (Redness, Edema, Ecchymosis, Discharge, Approximation) on the 3rd, 5th, and 7th days. The results showed a decrease in the REEDA score on post-test I (the 5th day), with an average score of 2.78 in the intervention group compared to the control group, which had an average REEDA score of 5.72. The administration of Bajakah tampala stem extract spray gel (Spatholobus littoralis Hassk.) affected perineal wound healing in postpartum women based on the REEDA score.

Education on Kegel Exercises as an Effort to Accelerate Healing of Perineal Wounds in Postpartum Mothers at the Driyorejo Gresik Community Health Center

Infections in the postpartum period are caused by delays in perineal wound healing. Kegel exercises are exercises to strengthen the pelvic floor muscles, help prevent urinary incontinence problems, and can stretch the perineal tissue as the baby's birth canal. Accelerate healing of perineal wounds in postpartum mothers at the Driyorejo Gresik Community Health Center through Kegel exercise education. This community service was carried out on postpartum mothers with perineal wounds in the Driyorejo Gresik Community Health Center working area in March 2024. The number of postpartum mothers who were given Kegel exercises was 30 people. Service activities are divided into 3 stages, namely preparation, implementation and evaluation. The results of the activity showed a decrease in REEDA scores after doing Kegel exercises. Giving Kegel exercises can speed up the healing of perineal wounds. Kegel exercises given to postpartum mothers for 7 days and done 3 times a day with movements that activate the pubococcygeal muscles can improve blood and oxygen circulation to the muscles and tissues around the perineum.

Obstetric anal sphincter injury in the second birth after perineal wound complication in the first birth: A nationwide register cohort study.

To investigate whether perineal wound complications in the first birth, alone or in conjunction with obstetric anal sphincter injury (OASI), is associated with an increased risk of OASI in the second birth. Nationwide population-based cohort study. Sweden. Women (n = 411 317) with first and second singleton vaginal births in Sweden, 2001-2019. Data on diagnostic codes and surgical procedures were retrieved from the Swedish Medical Birth Register and the Swedish Patient Register. A perineal wound complication was defined as wound infection, dehiscence or perineal haematoma within 2 months of childbirth. Associations between wound complications in the first birth and OASI in the second birth were investigated with logistic regression and presented as adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs). In total, 2619 (0.6%) women had a wound complication in the first birth, and 5318 (1.3%) had an OASI in the second birth. Women with a wound complication but no OASI in the first birth had more than doubled odds of OASI in the second birth (aOR 2.73, 95% CI 2.11-3.53). Women with OASI and a wound complication in the first birth had almost tenfold odds (aOR 9.97, 95% CI 6.53-15.24) of recurrent OASI. Perineal wound complication in the first birth increases the likelihood of OASI in a subsequent birth.

Differences in Perineal Wound Healing Between Doing Kegel Exercises and Not Doing Kegel Exercises

Perineal wounds are lacerations or injuries that occur along the birth canal (perineum) due to the delivery process. Wound healing is the process of replacing and repairing damaged tissue function. The purpose of this study was to see the difference in perineal wound healing between those who did Kegel exercises and those who didnot do Kegel exercises. The research method uses a Quasi-Experimental with the Posttest Only Control Group Design approach. The number of samples taken were 18 postpartum women with perineal wounds at PMB Sri Puji UW S.Tr.Keb. The sampling technique used was purposive sampling. Data collection techniques using observation sheets. Statistical test using the Mann Whitney. The results of the study after being given the treatment obtained the value of Asymp.Sig = 0.028, thus the Asymp.Sig was smaller than α &lt;0.05, thus it can be said that there was a difference in the group that did Kegel exercises and those who did not do Kegel exercises. Because there is a significant difference, it can be said that "there is an effect of doing Kegel exercises on the healing of perineal wounds in postpartum women" at PMB Sri Puji UW S.Tr.Keb Sampang. It is hoped that the results of the research can become information for the development of health sciences, especially health in postpartum women in healing perineal wounds and reducing delays in perineal wound healing. As well as management by doing Kegel exercises to speed up the healing process of perineal wounds.

The Relationship of Cleanliness and Vulva Hygiene in Postpartum Mothers' Perineal Wound Infection

Infection during the postpartum period is one of the reasons for the high number of deaths in Mothers. Data from the 2018 WHO shows that infection is the second cause of postpartum maternal deaths in the world. In Indonesia, infection contributes to 10% of deaths of mothers in Indonesia (Sarwono, 2018). Infection perineal wounds were 207 cases (West Java Health Office, 2021). Guard cleanliness and vulva hygiene with Correct can prevent infection of the mother's perineum postpartum. Research objectives This is, for now, the connection between cleanliness and vulva hygiene in infections postpartum mother's perineal wounds at PMB Midwife M in 2023. Types and Designs Study This use method survey analytic observational with a cross-sectional approach. Research sample This is a total sampling technique where the sample size is the same as the population, namely 30 people. Method of collecting data in research: This is done through questionnaires and sheet observations. Then, the data is analyzed in a way univariate and bivariate with the Chi-square test (X 2) at a significant level ? 0.05. The results of the study show that there were six respondents who did not do vulva hygiene well, and 1 of them experienced infection. Got its mark from variable vulva hygiene with incident infection perineal wounds p = 0.000. Results p value &lt;0.05, then Ha is accepted. Yes, there is a connection between cleanliness and vulva hygiene with incident infection perineal wounds in mothers postpartum in PMB M, the expected public can increase the role of active Mothers postpartum to get information about health, especially about vulva hygiene.

Effectiveness of Kegel Exercises on Perineal Wound Healing among Postpartum Women

Perineal wound refers to laceration or wound that occur along the birth canal (perineum) due to the delivery process. Wound healing is a method involved with replacement and repairment of the capacity of damaged tissue. This study aims to determine the effectiveness of Kegel exercises on perineal wound healing. This was a quasi-experimental study with one group pre-test – post-test design. 45 women with perineal wounds at the Arosbaya Bangkalan Community Health Center were selected as the study samples through a random sampling technique. Data were collected using observation sheet. t test was applied for the statistical tests. The study results obtained a calculated t value that was higher than the t table value (-16.523&gt;-2.015) and significance value of &lt;0.05 (0.000 &lt; 0.05). Thus, it can be concluded that H0 was rejected and H1 was accepted, which indicated an effect of Kegel exercises on perineal wound healing among postpartum women at Arosbaya Community Health Center, Bangkalan, both before and after Kegel exercises. It is expected that the study findings can provide information for the development of health science, especially regarding the health of postpartum women during perineal wound healing process. In addition, management through Kegel exercises to accelerate the perineal wound healing process is expected to eliminate delays in such process

Pulsating electromagnetic fields for perineal lacerations and surgical wounds healing in the postpartum: a pilot study

PurposeThe aim of our study was to assess the possible benefits of Therapeutic Magnetic Resonance (TMR) in the treatment of spontaneous perineal lacerations and episiotomies in the postpartum.MethodsWe performed a prospective, non-pharmacologic, non-profit, monocentric interventional study on women who had a spontaneous laceration and/or an episiotomy at delivery. The TMR device treatment was accepted by 52 women, while 120 women underwent standard care. Patients were visited 1 day postpartum, before starting the treatment; then a follow-up visit was performed at 3 weeks, 5 weeks, and 3 months after delivery. The main endpoint was the time required for complete healing of the laceration and/or the episiotomy. Secondary endpoints were the prevalence of dehiscence, infections, urinary discomfort, urinary leakage, and the quality of restoration of sexual function.ResultsIn the treatment group the REEDA score was significantly better both at 3- and 5-weeks postpartum follow-up. At 3 weeks and 5 weeks postpartum, we observed a significantly better outcome in the treatment group for all subjective complaints and perineal complications associated with lacerations and episiotomies. The percentage of patients who scored above the cutoff for sexual dysfunction was significantly better in the treatment group (83.3%) than in the control group (31.8%) (p < 0.001).ConclusionsWith this pilot study, we introduced low dose Pulsating Electromagnetic Fields (PEMFs) as a novel conservative and not pharmacological approach to reduce complications of perineal lesions. Our results demonstrated to significantly improve perineal wound healing and to ameliorate the sexual function in the postpartum.

Pengaruh Pemberian Seduhan Daun Sirih terhadap Lama Penyembuhan Luka Perineum Ibu Nifas di PMB Endang Pasar Minggu Jakarta Selatan

perineal injury in puerperal mothers refers to tears that occur in the birth canal, both caused by Labor and episiotomy. This tear can occur spontaneously or through an episiotomy. Perineal care is important to prevent infection, as inadequate care can lead to infection, which is one of the causes of postpartum maternal death. Based on this, the researchers tried an alternative by using betel leaf steeping to accelerate the healing of perineal wounds. This study aims to determine the effect of betel leaf steeping on the duration of perineal wound healing in puerperal mothers in PMB Endang Pasar Minggu, South Jakarta. this study uses a quantitative approach with Pre-Experimental design and One-Shot Case Study. The sampling technique used was consecutive sampling, with a total of 20 participants. research shows that most postpartum mothers experience rapid perineal wound healing after receiving treatment with betel leaf steeping. The one sample proportion test revealed that 60% of respondents experienced a decrease in perineal injuries after being given betel leaf steeping. there is an effect of betel leaf steeping on long-term perineal injury in puerperal mothers in PMB Endang Pasar Minggu Jakerta Selatan.

The Efficacy of Educational Videos on Perineal Wound Care Using Red Betel Extract Salve in Enhancing the Knowledge and Attitudes of Postpartum Mothers for Improved Healing

The Efficacy of Educational Videos on Perineal Wound Care Using Red Betel Extract Salve in Enhancing the Knowledge and Attitudes of Postpartum Mothers for Improved Healing

Penerapan Kegel Exercise terhadap Penyembuhan Luka Perineum pada Ibu Post Partum

Background: Post partum is a condition where the reproductive organs are restored to their pre-pregnancy state. The process of childbirth almost 90% experience perineal tears. To be able to accelerate perineal wounds can be with pharmacological and non-pharmacological measures, one of which is non-pharmacological action with kegel exercise, kegel exercise is pelvic muscle training by contracting the muscles. Objective: to describe the results of observations of wound healing and changes in wound characteristics in post partum women. Methods: This research is a case study research using descriptive methods, namely by observing 2 (two) respondents of post partum women with perineal rupture. Performed for 7 days of application and wound evaluation on day 8. Results: This application shows that before Kegel exercise was performed, both respondents' perineal wound conditions were classified as moderate wounds, namely wet wounds, perineal closure, no signs of infection. After evaluation on the eighth day, the wound condition of Mrs. D and Mrs. E was classified as a good wound, namely dry perineal wounds closing and no signs of infection. Conclusion: There are differences in wound healing and changes in perineal wound characteristics in postpartum women.

Effects of Far Infrared Radiation and Sitz Bath on Perineal Wound Healing and Pain in Primiparous Women Undergoing an Episiotomy: A Randomized Prospective Parallel Arm Study.

Introduction Episiotomy is a common surgical procedure done during childbirth. The study aims to assess the efficacy of far-infrared (FIR) and sitz bath (SB) effects on pain relief and healing of perineal wounds in primiparous women who had undergone an episiotomy. Materials and methods A randomized prospective parallel arm study was conducted among 208 primigravida women who underwent episiotomy in a tertiary hospital in the southern part of India from December 2020 to March 2022. Participants were randomized into the FIR (n-104) and SB therapy groups (n-104) and their efficacy was assessed for pain relief and healing of perineal wounds using the Visual Analog Scale (VAS), Redness, Oedema, Ecchymosis, and Discharge, the Approximation Scale (REEDA) and the Modified Oxford Scale (MOS). The variables were compared using an independent two-sample t-test and chi-square test (p ≤ 0.05). Results Pain was evaluated using VAS, and by the sixth week postpartum, 90.4% (94) of the FIR group reported mild to no pain compared to 88.5% (92) of the SB group. Wound integrity assessment using the REEDA scale showed better results among the FIR group (94, 90.4%) than the SB group (93, 89.4%) on the second day postpartum. Perineal muscle tone, measured by the MOS, was slightly better in the FIR group (59, 62.8%) than the SB group (55, 59.8%) at the sixth week postpartum, although these differences were not statistically significant. Conclusion FIR therapy reduces postpartum discomfort, promotes wound healing, and improves perineal muscle tone better than SB therapy. FIR also enhanced patient compliance and efficacy.

Abdominal Mesh Use in Pedicled Rectus Abdominis Flaps for Pelvic Reconstruction.

Rectus abdominis flap coverage of high-risk perineal wounds following extirpative pelvic procedures can result in improved perineal outcomes. However, rectus abdominis flap harvest has morbidity associated with the donor site, including hernia or bulge development. The risk-benefit profile of mesh use in this scenario is not well-defined in the literature. We performed a retrospective chart review of all patients who underwent rectus abdominis flap coverage of pelvic defects at our institution during July 2012-January 2021. Patient characteristics and postoperative outcomes were assessed. Patients were stratified into groups based on whether mesh was used and whether primary fascial closure was achieved. Donor site outcomes were analyzed between groups. One hundred consecutive patients were included. When considering all patients in whom primary fascial closure was achieved, the use of mesh did not significantly decrease rates of hernia development. Mesh use in this setting was associated with significantly greater rates of infection, requiring procedural intervention (12% versus 0%, P = 0.044). When considering all patients in whom mesh was used, primary fascial closure was associated with decreased rates of hernia development, and this trended toward significance (16.1% versus 0.0%, P = 0.058). When closing a pedicled rectus abdominis flap donor site, if primary fascial closure is achievable, the addition of mesh to reinforce the repair does not have an added benefit. Mesh use in this setting was not shown to prevent hernia or bulge development, and was found to be associated with significantly greater rates of infection, requiring procedural intervention.

A Case of Rectal Cancer Treated with Prophylactic Negative Pressure Closure Therapy for the Perineal Wound after Abdominoperineal Rectal Resection

A Case of Rectal Cancer Treated with Prophylactic Negative Pressure Closure Therapy for the Perineal Wound after Abdominoperineal Rectal Resection