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Cold therapy and perineal wounds: Too cool or not too cool?Perineal trauma following childbirth often has numerous negative consequences for many women and the associated pain can dominate the experience of early motherhood. Applications of cold compresses have been in use for centuries as a form of localized treatment and these have become a generally accepted method to treat acute injuries. However, concerns have been expressed as to whether cold therapy can delay wound healing. The purpose of this article is to review the recent evidence concerning the beneficial use of cold therapy, when applied locally to perineal wounds and non-perineal wounds and to consider if such treatment may have an adverse effect on the rate of wound healing. In addition, the mechanism of the action of cold therapy is discussed. We conclude that there is no clear evidence to support the suggestion that when controlled therapy is applied to the traumatized perineum or other injured parts of the body that this will result in a delay in wound healing. Such treatment should continue until clear evidence is produced to the contrary.
Effectiveness of cooling gel pads and ice packs on perineal painThe purpose of this paper is to report the findings of a randomised controlled trial undertaken at the Hazrat Ommolbanin University Maternity Hospital in Mashhad, Iran which investigated the effectiveness of localised cooling treatments to alleviate perineal trauma. From October 2005 to February 2006, 121 primiparous women who were at term and had an episiotomy were randomly recruited to one of three treatment groups (Group 1 - no localised cooling, Group 2 - Ice pack, Group 3 - cooling gel pad). The intensity of pain, wound healing and women’s satisfaction levels were the main outcomes measured. The intensity of pain was measured by a (Numeric Rating Scale (NRS) (0-10) and wound healing was evaluated by the REEDA scale within 4 hours of episiotomy repair, at Day 1, Day 2, Day 5 and finally at Day 10. The usage of oral analgesia (acetaminophen) was measured at Day 10. Women’s satisfaction levels with oral analgesia and localised cooling treatments were also assessed at Day 10 by a NRS (0-10). There was evidence that localised cooling treatments are effective at alleviating perineal pain which was in favour of the cooling gel pad group. A statistical significant difference was reported at 4 hours (p=0.003) Day 2 (p=0.004) and at Day 10 (p=0.044). At Day 1 and Day 5 there was evidence of a reduction in the intensity of pain but this did not reach a statistical significant difference. A reduction in the usage of oral analgesia (acetaminophen) was reported in favour of the cooling gel pad group (p<0.001). Women’s satisfaction levels with oral analgesia were similar within the three treatment groups but a higher level of satisfaction when assessing localised treatment was reported by the cooling gel pad group (p<0.001). Wound healing rates were also reported to be better in the cooling gel pad group when compared to the other two groups(p<0.001). In conclusion, treatments to alleviate perineal pain without any adverse affects on wound healing and women’s views are important aspects of midwifery care. This trial has demonstrated evidence that localised cooling of the perineum reduces the intensity of pain, women were more satisfied when applying cooling gel pads and this treatment appeared to assist in wound healing.
Perineal tears and episiotomy: How do wounds heal?The care of perineal wounds is an important aspect of postnatal care. This article focuses on the healing of perineal wounds, describes tissue trauma, different types of wounds and classification of perineal wounds. Wound healing, factors that can prevent healing and the need to provide adequate pain relief that will have no adverse effect on healing are discussed in detail.