The effect of postpartum interventions on healing and pain in women with perineal trauma: A systematic review and meta-analysis

Introduction

Interventions aimed at perineal healing and pain relief can have a positive impact on postpartum experiences in women who experience perineal trauma during childbirth.

Objective

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.

Methods

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.

Results

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).

Conclusion

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.