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The initial aim of this study was to develop a reliable visual tool to assist in the assessment of the severity of oedema and bruising in perineal trauma, using a categorical scale of ‘none’, ‘mild’, ‘moderate’ and ‘severe’. A standardised set of photographs was selected by 10 clinically experienced midwives to represent these categories. The tool was tested in a clinical trial involving 77 women, recording and monitoring changes in the level of oedema and bruising during the first 48 hours following suturing of an episiotomy. The results demonstrated a statistically significant change for both oedema and bruising. However, the less experienced assessors reported some uncertainties in assessing a small proportion of women. A combined method, using this tool with a categorical scoring scale, was used to minimise difficulties in the assessment. Two pairs of midwives, one pair very experienced in assessing perineal trauma and the other less experienced, evaluated the combined method. The results showed a high level of agreement. The standard set of photographs and categorical scoring scale together resulted in a reliable and sensitive assessment tool to evaluate severity of perineal trauma.

The development and evaluation of a maternity gel pad for the alleviation of perineal pain

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.

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