• CELLMED
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• v.11 no.4
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• pp.17.1-17.4
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• 2021

Episiotomy is the commonest obstetrics intervention in the world to reduce severe perineal injuries. Its prevalence is 43% to 100% in primiparous women in Asia. Further, worldwide approximately 10-95% of pregnant women undergo episiotomy incision during birth. Delay in wound healing probably increases the risk of wound infection, changes the muscular structure, and ultimately causes muscle tone loss. So, wound care is of specific significance to postnatal maternal outcomes. Hence, this case study aimed to evaluate the effect of Marham-i-Raal in episiotomy wound healing and pain relief. The study was conducted in eleven postpartum primi or multipara pregnant women aged between group 19 and 35 years with term gestational age, singleton pregnancy in a cephalic presentation who had a normal vaginal delivery with mediolateral episiotomy, without a perineal tear, and perineal hematoma. Externally, application of Marham-i-Raal 2g on episiotomy incisional wound, twice a day for 10 days was advised. Wound healing of episiotomy and pain intensity was assessed with REEDA ["redness, oedema, ecchymosis, discharge and approximation of the edges"] scoring and VAS scoring for pain intensity respectively. At one hour (baseline), the REEDA mean score of eleven patients was 3.90±1.04 whereas on day 7-10 it was 0.18±0.40 with statistically significant difference (p<0.001). The VAS mean score at one hour was 6.90±1.22 whereas on day 7-10 it was 0.72±0.78 with a statistically significant difference (p<0.001). Marham-i-Raal would be effective in episiotomy wound healing and reducing pain intensity. Further, randomized double-blind controlled trials in large sample size are recommended.

• Women's Health Nursing
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• v.7 no.3
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• pp.393-406
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• 2001

The purpose of this study was to find out women's need and level of knowledge about episiotomy, pain and discomfort related to episiotomy on a cross-sectional survey design. The subjects were 102 postpartal women agreed on oral consent. 34 postpartal women admitted at obstetric ward of H university hospital, 34 postpartal women admitted at 2 Sanhujoriwons, and 34 women within one year afterbirth. They were selected in Seoul, Korea. Data were collected from July, 1 to September 30, 2000, by a structured questionnaire. The instrument used for this study was a questionaire consisted of 5 items of general characteristics, 12 items of obstetric characteristics, 10 items of level of knowledge (Chronbach $\alpha$ .8176), 8 items of need of education(Chronbach $\alpha$ .8836), 3 items of pain (Chronbach $\alpha$ .9252), and 3 items of discomfort (Chronbach $\alpha$ .8092). The data were analyzed by the SPSS/PC+ program using t-test, ANOVA and Scheffe test as a post hoc and Pearson Correlation Coefficient. The results of the study were as follows; 1. 63.2% of respondents had right answer on 6-8 items among 10 items. Only 4.4% of women got right answer on 10 items all. 2. The need of education was high(4.45%) on all items and the range of score was $4.25{\sim}4.64$. 3. The strength of pain was the highest within one week afterbirth(5.93/10) and became lower in 8-14 days afterbirth(2.55). And after 15days of postpartum, the pain level became to the lowest level(1.08). However, pain was delayed until more than one month afterbirth. 4. The level of discomfort was the highest one week afterbirth(6.88/10) and became lower in 8-14 days afterbirth(4.20). And after 15days of postpartum, the discomfort level became to the lowest level(2.47). Universally, the degree of discomfort was higher than pain. 5. There was a strong positive correlation between discomforts and pain ($r=.752^{**}$) and weak positive correlation between discomforts and the level of educational need($r=.308^*$). In conclusion, women have a right to choose whether she will have episiotomy or not according to her decision making based on the comprehensive knowledge of episiotomy before they get episiotomy with consent process and explanation in detail. Women health care providers like nurses have a responsibility to do conscious raising and empowerment for women so that they could lead themselves to choose given medical treatments for women's health and wellbeing and the quality of life in her life cycle.

• Journal of Korean Academy of Nursing
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• v.21 no.1
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• pp.27-40
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• 1991

Perineal discomfort from episiotomy continues to be a problem for many postpartum women. The purposes of this study were to compare the effect of ice bag and heat lamp for the relief of perineal discomfort and to identify the sustaining time of each effect. Forty women took ice bag and heat lamp with random assignment of initial therapy. Women rated the degree of perineal discomfort before and after each therapy and at half-hour, tow-hour and four-hour intervals after each therapy. A discomfort scale, 18cm graphic rating scale, was used. The results of the study were as follows ; 1. The ice bag group showed significantly lower discomfort score than the heat lamp group at the half- hour and two - hour intervals after therapy. 2. The ice bag group showed significantly lower discomfort score for 4hrs after than before therapy, but the heat lamp group did not show significantly lower discomfort score. 3. Neither the type of episiotomy nor the previous experience of heat therapy influenced on the effect of ice bag relieving the perineal discomfort. Therefore ice bag was significantly mere effective in relieving perineal discomfort than heat lamp. Subjective responeses of patients who took both therapy were very favorable toward ice bag. I suggested that nurses should provide women with adequate information about the use of ice bag and encourage to apply ice bag instead of heat lamp after episiotomy in order to promote the relief of perineal discomfort and the healing of perineal wound.

• Journal of Korean Academy of Nursing
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• v.34 no.1
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• pp.53-62
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• 2004

Purpose This study was designed to verify the effect of aromatherapy on a postpartum mother's perineal healing. Method The research design was a clinical trial. The methods of aromatherapy were applied sitz bath or soap application using essential oils with Lavender, Myrrh, Neroli, Rose, Grapefruit, Mandarin, Orange, and Roman Chamomile. The subjects of this experiment were postpartum mothers who delivered vaginally with an episiotomy. They were allocated to one of three groups; the aroma-sitz bath group, aroma-soap application group or control group. To evaluate the effect of aromatherapy, the perineal healing status was measured using the REEDA scale and smears of episiotomy wound were obtained. The data were analyzed by repeated measures of ANOVA, ANCOV A, x$^2$- test, and multiple response analysis via SPSS program. Results The REEDA scale was significantly low in the experimental group at postpartum 5th and 7th days (P=.009, P=.003), respectively. Most were observed ‘few’(5-10 bacteria per field) bacteria in the smears of episiotomy wound. The one bacteria was identified in the 50.8% of subjects in pretest and two bacteria in the 60.3% in posttest. Most frequently identified bacteria were Escherichia coli and Enterococcus faecalis. Conclusion In conclusion, these findings indicate that postpartum aromatherapy for perineal care could be effective in healing the perineum perineal care could be effective in healing the perineum.

• Women's Health Nursing
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• v.4 no.1
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• pp.67-83
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• 1998

A quasi-experiment, repeated measures design with non-equivalent control group was used to test the influence of cold therapy on the perineal discomfort and the healing state of the postpartum women undergoing vaginal delivery with episiotomy. Experiment was carried out from July 28, through October 2, 1996 with 40 postpartum women conveniently sampled from one university hospital located in Seoul. The 40 postpartum women undergoing vaginal delivery with episiotomy were as signed to experimental and control groups evenly(20 each). The instrument of measurement of perineal discomfort was 0-10 rating scale that was made by researcher and that of perineal healing state was Davidson's REEDA tool. The perineal discomfort and the healing state level were measured before and after each treatment. The treatment using ice glove that was given for the only experimental group was carried out at three points ; as soon as returning to the recovery room, 3 hours after returning to the recovery room and 6 hours after returning to the recovery room. The data was analysed by using t-test, chi-square test to determine the similarity between experimental and control groups. The hypotheses were tested using repeated measures ANOVA. The results of this study are summarized as follows; 1. The first hypothesis that the perineal discomfort level of the experimental group will be significantly lower than that of the control group(df(1,38), F=24.12, p=.0001) was supported. 2. The second hypothesis that the perineal healing state of the experimental group wil be better than that of the control group(df(1,38), F=0.48, p=.49) was not supported. Based on the results of this study, could therapy was turned out to have significant effect on the perineal discomfort of the postpartum women undergoing vaginal delivery with episiotomy.

• Women's Health Nursing
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• v.18 no.3
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• pp.209-222
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• 2012

Purpose: The purpose of this study was to determine whether upright position is effective in labor through systematic review in randomized controlled trials. Methods: We established the PICO (Patient-Intervention-Comparator-Outcome) strategy, and reviewed 282 literatures from national and international electronic databases, and finally selected 9 references based on inclusion and exclusion criteria. We evaluated the quality of references and carried out a meta-analysis. Results: The maternal outcomes showed that the duration of their second-stage labor was 2.29 minutes shorter than that of the women in the recumbent position, and were less likely to have episiotomy. The other outcomes, including the mode of delivery, blood loss, hemoglobin level, use of oxytocin, use of analgesics, and perineal laceration, did not differ between the groups. The fetal heart rate abnormality occurred less than in the control group. The Apgar scores of the groups did not differ. Conclusion: There is evidence that an upright position in the second stage of labor reduces the duration of the second stage of labor, the incidence of episiotomy, and an abnormal fetal heart rate.

• Journal of Korean Academic Society of Home Health Care Nursing
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• v.4
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• pp.65-75
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• 1997

The needs for the home care of postpartum mothers and their infants are increasing, but the quality control of home care nurses is not developed yet. The objective of this study is to develop assessment - intervention algorithms for the home care of postpartum mothers and their infants. We can use these algorithms when we assess the client's condition, and find appropriate nursing interventions. Also, these algorithms can offer guidelines for home care nurses, so that standardization of home care can be attained. Common problems for postpartum mothers are postpartum hemorrhage, abnormal vaginal discharge(endometritis), episiotomy pain, breast problems, breastfeeding difficulty, edema, urinary dysfunction and defecation difficulties. Also, commom problems for infants are abnormal body temperature, tarchycardia, respiratory problem, neonatal jaundice, cord problem, abnormal stool, breast feeding, and bathing. These algorithms can be used as a basis for the development of computerized infomation system for the home health care.

• Korean Parent-Child Health Journal
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• v.3 no.2
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• pp.67-80
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• 2000

This study was described as midwife's role and obstacle of midwife's role expansion. Midwife as primary medical personal who practices for a mother and infant health care and promotion of mother infant interaction. As the trend of increasing natural childbirth, midwifery has to provide childbearing care those who want delivery in a midwifery center. This study conducted to survey for 44 midwives who work at the midwifery center. The results of the study as fellows. 1. Most of the midwives role was care of pregnancy, delivery, postpartum women and babies. Another role was conducted educational classes childbirth, breast feeding, contraception and sexual education. 2. Some midwives role perform breech, vaccum delivery, episiotomy and suture, pitocin induction and augmentation, ultrasonogram, giving medication, anesthesia, collecting specimen from Pap smear and vaginal discharge. Midwife perform these roles without medical law support. 3. Most of the obstacles of the midwife role was the medical law limitation. Midwives want revise medical law to perform simple treatment for childbearing women and babies. 4. Half of the midwives refer cases to medical doctor in case of complication of women and newborns. 5. Current frequency of home birth rate is slightly higher than before and me cases like to have delivery under water. Finally, midwife and midwifery have to prepare to meet childbearing woman, baby and family's need. For activation and expansion of midwife's role, every midwife has to be aware of medical law accurately and they must know what practice they can do and what practice they can not do.

• Clinical and Experimental Reproductive Medicine
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• v.20 no.2
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• pp.177-181
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• 1993

Endometriosis involving sites outside the pelvic cavity is a relatively uncommon occurrence and its frequency is cited as being less than one percent of all occurences of endometriosis. Sites previously reported in literature have described involvement of the extraperitoneal portion of the round ligament, the rectosigmoid, the appendix, and the ileum. Other more distal sites reported to have been found to have endometriosis lesions include the inguinal ligaments, the umbilicus, abdominal incisional wounds, thoracic lesions involving the pleura or diaphragm which may result in catamenial pneumothorax, the kidneys, and vulvar episiotomy wounds. Endometriosis have even been reported to occur in males. In this presentation, three cases of endometriosis, two involving the vulvar area and one involving a Pfannenstiel incision wound, is presented with a review of the pertinent literature in order to discuss its etiology, pathology, diagnosis and treatment.

• The Journal of Korean Obstetrics and Gynecology
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• v.23 no.1
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• pp.97-107
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• 2010

Purpose: This study was designed to verify the effect of Herbal Decoction for Sitz Bath on postpartum mother's perineal healing. Methods: Women who had given birth vaginally and had an episiotomy were included in study. The primary outcome for study was severity of pain, discomfort, rated on a 10-cm visual analog scale from 0("no pain") to 10("worst pain ever"). As a secondary outcome, we also evaluated side effect and "feeling". Results: In clinical trial, perineal pain, perineal discomfort, after-pain were significantly low at postpartum 3th days, respectively. And mothers were satisfied with "Herbal Decoction for Sitz Bath". Conclusion: According to these results, we finally concluded that "herbal decoction for sitz bath" for perineal care could be effective in healing the perineum.