Comparing the Effect of Colling Gel Pads and Ice Pack, after Episiotomy, on the Intensity od Perinal Pain

Document Type : Original Article

Authors

Abstract

Introduction: There are still considerable morbidities associated with childbirth, despite of the fall in material mortality in the last country. Episiotomy is performed for most of primiparous women and the pain related to this treatment is typically treated with oral analgesic medications. Application of cooling devices is a new approach in pain reliefe.
 
This research was carried out, from October 2005 to February 2006, to determine the effect of two cooling devices (gel pad and ice pack) on the intensity of perineal pain and to compare its effects with no localised treatment regime (control) in women who gave birth at Hazrat Ommolbanin University Maternity Hospital in Mashhad –Iran.
 
Material and Methods: In this randomized controlled trial, 121women, with the necessary criteria were sampled and randomely allocated in the two groups of cold therapy (ice pack, cooling gel pad) and the control group (acetaminophen). At hospital, during a period of 4 hours after episiotomy, and then on demand of individuals, to reclnce the intensity of perineal pain at home, subjects received analgesia. During the first 4 hours and on the days 1, 2, 5, 10 after episotomy, perineal pain intensity was evaluated, using Numeric Rating Scale (NRS). Evaluation of women satisfaction from analgesia accomplished on the day 10. Data analyzed by statistics parametric and nonparametric methods, using the SPSS software.
 
Results: There was a statistically significant difference in the intensity of perineal pain in three groups at 4 hours (p=0.003) and on the day 10 (p= 0.044), after episiotomy, which was in favour of the maternity gel pad group. A considerable variation, observed in the reduced necessity for medication and satisfactory treatment, among three groups.
 
Conclusion: Maternity gel pads are effective in reducing the perineal pain intensity, and the need for medication. Therefore, cooling gel pads are suggested as a safe and adequate method of perineal pain relief, which is applicable both at hospital and home.

Keywords


1. Fernando RJ, Sultan AH. Risk factors and management of obstetric perineal injury .J Current
Obstet & Gyneacol 2004;14:320-26l.
2. Albers LA, Sedler KD, Bedrick EJ, Teaf D, Peralta P. Midwifery care measures in the second
stage of labor and reduction of genital tract trauma at birth:a randomized trial. J Midwifery
Womens Health 2005; 50(5):365-72.
3. Otoide V O ,Ogbonmwan S M,Oknofua FE. Episiotomy in Nigeria. Int J Gynecol Obstet 2000;
68:13-17. Available from URL at : http://www.elsevier.com/locate/ijgo.
4. Andrews V ,Thakar R , Sultan AH, Jones PW. Are mediolateral episiotomies actually
mediolateral. BJOG 2005; 112:1156-8.
5. Lowenstein L, Drugan A, Gonen R, Itskovitz-Eldor J, Bardicef M, Jakobi P. Episiotomy:beliefs, Practice
and the impact of educational intervention. Eur J Obstet Gynecol Reprod Biol 2005; 123:179-182.
6. Low LK , Seng JS, Murtland TL, Oakley D. Clinican-specific episiotomy rates:impact on
perineal outcomes . J Midwifery womens Health 2000; 45(2):87-93.
7. Borghi J, Fox-Rushby J, Bergel EAbalos E,Hutton G,Carroli G. The cost-effectiveness of routine
versus restrictive episiotomy.
8. CLemans JL ,Towers GD ,mcClure GB,O' Boyle AL. Decreased anal sphincter Lacerations
associated With restrictive episiotomy in use. Am J Obstet Gynecol 2005; 192:1620-5.
9. Ghosh C,Mercier F,Couaillet M,Benhamou D. Quality-assurance program for the improvement
of morbidity during the first three postpartum days following episiotomy and perineal trauma. Ac
pain 2004; 6:1-7 Available from URL at:http:// www.elsevier.com/locate/acpain.
10. Stepp KJ, Siddiqui NY, Emery SP, Barder MD. Text book recommendations for preventing and
treating perineal injury at vaginal delivery. Obstet Gynecol 2006; 107(2):361-6.
11. Enkin M, Neilson J, Crowther C, Duley L,Hodnelt E. Repair of perineal trauma. In:A Guide to
effective care in pregnaney and child birth .3rd ed.oxferd,uk:oxford university press;2000. p.341-4.
Available from URL at: http://www.maternitywise.org/prof/chap36.
12. Fernando RJ, Sultan AH, Radleys Jones PW, Johanson RB. Anal sphincter injury at Childbirth.
BMC Health Serv Res 2000;2(1):9-12.
13. Enkin M, Keirse M, Neilson J, crowther C, Duley L, Hodnett E. Perineal pain and discomfort. In:
A Guide to effective care in pregnancy and childbirth. 3rd ed.oxford,uk:oxford university
press;2000. p.457-66. Available from URL at: http://www.maternitywise.org/prof/chap46
14. Steen MP , Marchant P. Alleviating perineal trauma-the APT study. Rcm Midwives J 2001; 4(8):256-
9.
15. Steen MP. Perineal trauma:how do we evaluate it's severity . Midirs midwifery digest 1998; 8(2):228-23.
16. Steen MP, cooper K. Cold therapy and perineal wounds:too cool or not too cool?. BJ midwifery
1998; 6(9):572- 9.
17. Kropp N,Hartwell T,Althabe F. Episiotomy rates from eleven developing countries. Int J
Gynecol Obstet 2005; 91:157-159.
18. Williams FL, Duvflorey C, Milres G J, Ogston SA. Episiotomy and perineal tears in low-risk Uk
Primigravida. BJOG 2002; 109(9):1066-8.
19. Abraham S. pain and dyspareunia. Med J Aust 1990; 152(1):9-12.
20. Woolley RJ. Benefits and risks of episiotomy: A review of the English-language literature part &
partObstetGynecolsurvey1995;50:806-35.AavailablefromURL
t:http://www.sigo.it/Documenti/Journal/ItalianJournal18N1.6.pdf
21. Dodd JM, Hedayati H, Pearce E, Hotham N, Crowther CA. Rectal analgesia for the relief of
perineal pain after childbirth:a radomised controlled trial of diclofenac suppositories. BJOG
2004; 111(10):1059-65.
22. Searles jA , Pring DW. Effective analgesia following perineal injury during childbirth:a placebo
controlled trial of prophylactic rectal diclofenac. BJOG 1998; 105(6):627-31.
23. Calvert S, Phil MM, Fleming V. Minimizing postpartum pain:a review of research pertaining to
perineal care in childbearing women. J Adv Nurs 2000; 3202:407-17.
24. Kenyon S, Ford F. How can we improve women's postbirth perineal health? Midirs Midwifery
Digest 2004; 14(1):7-12.
25. Bleakley CH, Mcdenough S, Macauley D. The use of ice in the treatment of acut soft-tissue
injury. Am J sports Med 2004; 32(1):251-1.
26. Steen MP, CooperK. A new device for the treatment perineal wound. J wound Care 1998; 8(2):87-90.
27. Merrick MA, Jutt LS, Smith ME. Cold modalities with different thermodynamic properties
produce different surface and intramascular temperatures. J Athl Train2003; 38(1):28-33.
28. Hubbard TJ, Denegar CR. Does cryotherapy improve outcomes with soft tissue ingury?. J Athl
Train 2004; 30(3)87-90.
29. Aytan H, Tapisiz OL, Tuncay TG, Avsar FA. Sever perineal laceration in nulliparous women
and episiotomy type. Eur J Obstet Gynecol Reprod Biol 2005;121:46-50.
30. Fitzpatrick M, Cassidy M, Oconnell PR, Ohertihy C. Experience with an obstetric perineal clinic.
. Eur J Obstet Gynecol Reprod Biol 2002; 100:199-203.
31. Peter EA, Janssen PA, Grange CS, Dauglas MJ. Ibuprofen versus acetaminophen with codein for
the relief of perineal pain after childbirth :a randomized controlled trial. CMAJ 2001; 165 (9):
1203-9..
32. Pillitteri A . Maternal child health nursing:care of the childbearing & childbearing family. 2nd
ed. Philadelphia: J. B.lippincott;1995. p.620.
33. Karacam Z, Eroglu K. Effects of episiotomy on bonding and mother's health . J Adv Nurs 2003;
43(4):384-94.
34. Thacker SB. Midline versus mediolateral episiatomy" Br Med J 2000; 320:1615-6.
35. Kettle C, Jonson RB. Absorbable syntheric versus catgut suture material for perieal repair
(Cochrane Review). In: The Cochrane library, Issue2, 2004. oxford:update software.
36. Greenberg JA, Lieberman E, Cohen AP, Ecker JL. Randomized comparison of chromic versus
fast-absorbing polyglactin 910 for postpartum perineal repair. Obstet ynecol 2004; 103(6):1308-
13.
37. Paterson C, Symons L, Britten N,Barghs J. Developing the medication change questionnaire. J
Clinl pharm Ther 2004;29(4):339-349.