Postpartum management of perineal injury - A critical narrative review of level 1 evidence

White C, Atchan M · Midwifery · 2022 September

DOI 10.1016/j.midw.2022.103410

Objective

To review the high-level evidence informing postpartum management of perineal trauma.

Conclusions

There is an overall lack of focused high-quality research to inform management of perineal injuries beyond the acute postnatal period. Clinical trials that include women’s satisfaction and wellbeing as outcome measures are limited.

Critical Appraisal

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Insights

It is vital that women are provided with evidence-based postnatal care strategies to enhance perineal healing and resumption of normal activities.

This critical narrative review focuses on the postnatal management of perineal trauma, encompassing topics such as analgesic medication, suturing techniques, cryotherapy, use of antibiotics, ultrasound, physiotherapy, and complementary therapies. The review includes 19 systematic reviews, most of which pertain to the early or acute postnatal period. The findings are varied, with acknowledged limitations due to factors like small sample sizes and a low number of randomized controlled trials. The review highlights a scarcity of high-quality research addressing the management of perineal injuries beyond the acute postnatal phase. It emphasizes the need for further research, especially for women experiencing ongoing symptoms, and suggests incorporating women's satisfaction and wellbeing as crucial outcome measures in future clinical trials. The review underscores the importance of providing evidence-based postnatal care strategies to facilitate perineal healing and a return to normal activities for women.