Kurnaz Döndü, Fışkın Siyahtaş Gamze, Demirgöz Bal Meltem
Marmara University, Faculty of Health Sciences, Division of Midwifery, Istanbul, Turkey.
Marmara University, Faculty of Health Sciences, Division of Midwifery, Istanbul, Turkey.
Int J Nurs Stud. 2025 Feb;162:104976. doi: 10.1016/j.ijnurstu.2024.104976. Epub 2024 Dec 5.
Interventions aimed at perineal healing and pain relief can have a positive impact on postpartum experiences in women who experience perineal trauma during childbirth.
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.
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.
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).
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.
旨在促进会阴愈合和缓解疼痛的干预措施，可对分娩时经历会阴创伤的女性的产后体验产生积极影响。
本系统评价和荟萃分析的目的是基于原始研究比较用于会阴创伤愈合和疼痛缓解的各种方法。
研究方案按照PRISMA指南和荟萃分析指南制定。于2024年3月至4月进行检索。使用PROSPERO完成注册。通过PubMed、考科蓝图书馆、EBSCO、Embase、科学网、PsycINFO、Scopus、国家论文中心、TR Dizin、土耳其临床中心和DergiPark学术搜索引擎进行检索。使用RoB - 1和RoB - 2评估研究的方法学质量。通过荟萃分析汇总数据，并创建GRADE证据概况。
19项研究（涉及1899名参与者）纳入了荟萃分析。结果显示，会阴切开术后24小时内进行的干预措施并未减轻疼痛。然而，在第二天观察到了干预措施的效果，其中冷敷被确定为最有效的方法。此外，干预措施在前三天并未影响愈合，但到第五天，干预组有更明显的改善。即使不进行干预，愈合也在第7 - 10天左右开始。接受会阴教育（饮食、凯格尔运动、感染症状和会阴卫生）的组中，REEDA（发红、水肿、瘀斑、分泌物和愈合情况）评分下降最为显著。
建议在第二天进行冷敷以减轻会阴创伤后的疼痛。发现干预措施通过至少提前两天启动愈合来加速愈合过程，其中会阴教育是最有效的方法。然而，需要对局部草药治疗和会阴卫生教育进行进一步研究以加强这一证据。
