Postpartum perineal care and management of complications
- Lori R Berkowitz, MD
Lori R Berkowitz, MD
- Assistant Professor
- Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- Caroline E Foust-Wright, MD, MBA
Caroline E Foust-Wright, MD, MBA
- Assistant Professor of Urology/Obstetrics and Gynecology
- Tufts School of Medicine
- Section Editors
- Linda Brubaker, MD, FACOG
Linda Brubaker, MD, FACOG
- Section Editor — Female Pelvic Medicine and Reconstructive Surgery
- Health Sciences Clinical Professor
- University of California, San Diego
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
This topic presents information on routine postpartum perineal care as well as evaluation and management of delivery-related perineal complications. Despite the importance of postpartum perineal care, there is little evidence to guide management; the information in this topic is based largely on our clinical experience.
In our experience, common postpartum perineal issues include pain control, hygiene, prevention of constipation, and resumption of sexual activity. Clinicians should be able to evaluate less common symptoms, such as severe pain, bulge or mass, or abnormal discharge, including fecal leakage.
Related topics that are presented separately include:To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice, Association of Women’s Health, Obstetric and Neonatal Nurses. Committee Opinion No. 666: Optimizing Postpartum Care. Obstet Gynecol 2016; 127:e187.
- Hill PD. Effects of heat and cold on the perineum after episiotomy/laceration. J Obstet Gynecol Neonatal Nurs 1989; 18:124.
- Ramler D, Roberts J. A comparison of cold and warm sitz baths for relief of postpartum perineal pain. J Obstet Gynecol Neonatal Nurs 1986; 15:471.
- Sleep J, Grant A. Effects of salt and Savlon bath concentrate post-partum. Nurs Times 1988; 84:55.
- East CE, Begg L, Henshall NE, et al. Local cooling for relieving pain from perineal trauma sustained during childbirth. Cochrane Database Syst Rev 2012; :CD006304.
- Beleza AC, Ferreira CH, Driusso P, et al. Effect of cryotherapy on relief of perineal pain after vaginal childbirth with episiotomy: a randomized and controlled clinical trial. Physiotherapy 2016.
- Hedayati H, Parsons J, Crowther CA. Topically applied anaesthetics for treating perineal pain after childbirth. Cochrane Database Syst Rev 2005; :CD004223.
- Wuytack F, Smith V, Cleary BJ. Oral non-steroidal anti-inflammatory drugs (single dose) for perineal pain in the early postpartum period. Cochrane Database Syst Rev 2016; 7:CD011352.
- Chou D, Abalos E, Gyte GM, Gülmezoglu AM. Paracetamol/acetaminophen (single administration) for perineal pain in the early postpartum period. Cochrane Database Syst Rev 2013; :CD008407.
- Hay-Smith EJ. Therapeutic ultrasound for postpartum perineal pain and dyspareunia. Cochrane Database Syst Rev 2000; :CD000495.
- Hajhashemi M, Ghanbari Z, Movahedi M, et al. The effect of Achillea millefolium and Hypericum perforatum ointments on episiotomy wound healing in primiparous women. J Matern Fetal Neonatal Med 2017; :1.
- Wald A, Van Thiel DH, Hoechstetter L, et al. Effect of pregnancy on gastrointestinal transit. Dig Dis Sci 1982; 27:1015.
- Lawson M, Kern F Jr, Everson GT. Gastrointestinal transit time in human pregnancy: prolongation in the second and third trimesters followed by postpartum normalization. Gastroenterology 1985; 89:996.
- Turawa EB, Musekiwa A, Rohwer AC. Interventions for preventing postpartum constipation. Cochrane Database Syst Rev 2015; :CD011625.
- Almarzouqi F, Grieb G, Klink C, et al. Fatal Necrotizing Fasciitis following Episiotomy. Case Rep Surg 2015; 2015:562810.
- Lynch CM, Pinelli DM, Cruse CW, et al. Maternal death from postpartum necrotizing fasciitis arising in an episiotomy: a case report. Infect Dis Obstet Gynecol 1997; 5:341.
- Ruparelia BA, Robson P, Iqbal I, Johnson IR. Use of povidone-iodine in post-delivery perineal repairs: A prospective trial. Journal of Obstetrics & Gynaecology 1990; 10:202.
- Dudley LM, Kettle C, Ismail KM. Secondary suturing compared to non-suturing for broken down perineal wounds following childbirth. Cochrane Database Syst Rev 2013; :CD008977.
- National Collaborating Centre for Women's and Children's Health (UK). Intrapartum Care: Care of Healthy Women and Their Babies During Childbirth, RCOG Press, London 2007.
- Royal College of Obstetricians and Gynaecologists. Green-top guideline 27. In: The Management of Third and Fourth-degree Perineal Tears, RCOG, London 2007.
- Zahn CM, Yeomans ER. Postpartum hemorrhage: placenta accreta, uterine inversion, and puerperal hematomas. Clin Obstet Gynecol 1990; 33:422.
- Kainu JP, Halmesmäki E, Korttila KT, Sarvela PJ. Persistent Pain After Cesarean Delivery and Vaginal Delivery: A Prospective Cohort Study. Anesth Analg 2016; 123:1535.
- Signorello LB, Harlow BL, Chekos AK, Repke JT. Postpartum sexual functioning and its relationship to perineal trauma: a retrospective cohort study of primiparous women. Am J Obstet Gynecol 2001; 184:881.
- Leeman L, Rogers R, Borders N, et al. The Effect of Perineal Lacerations on Pelvic Floor Function and Anatomy at 6 Months Postpartum in a Prospective Cohort of Nulliparous Women. Birth 2016; 43:293.
- Fodstad K, Staff AC, Laine K. Sexual activity and dyspareunia the first year postpartum in relation to degree of perineal trauma. Int Urogynecol J 2016; 27:1513.
- Sayed Ahmed WA, Kishk EA, Farhan RI, Khamees RE. Female sexual function following different degrees of perineal tears. Int Urogynecol J 2016.
- Deffieux X, Vieillefosse S, Billecocq S, et al. [Postpartum pelvic floor muscle training and abdominal rehabilitation: Guidelines]. J Gynecol Obstet Biol Reprod (Paris) 2015; 44:1141.
- Battut A, Nizard J. [Impact of pelvic floor muscle training on prevention of perineal pain and dyspareunia in postpartum]. Prog Urol 2016; 26:237.
- Kolberg Tennfjord M, Hilde G, Staer-Jensen J, et al. Effect of postpartum pelvic floor muscle training on vaginal symptoms and sexual dysfunction-secondary analysis of a randomised trial. BJOG 2016; 123:634.
- Woodward AP, Matthews CA. Outcomes of revision perineoplasty for persistent postpartum dyspareunia. Female Pelvic Med Reconstr Surg 2010; 16:135.
- Dionisi B, Senatori R. Effect of transcutaneous electrical nerve stimulation on the postpartum dyspareunia treatment. J Obstet Gynaecol Res 2011; 37:750.
- Mathé M, Valancogne G, Atallah A, et al. Early pelvic floor muscle training after obstetrical anal sphincter injuries for the reduction of anal incontinence. Eur J Obstet Gynecol Reprod Biol 2016; 199:201.
- Li C, Gong Y, Wang B. The efficacy of pelvic floor muscle training for pelvic organ prolapse: a systematic review and meta-analysis. Int Urogynecol J 2016; 27:981.
- Lewicky-Gaupp C, Leader-Cramer A, Johnson LL, et al. Wound complications after obstetric anal sphincter injuries. Obstet Gynecol 2015; 125:1088.
- Williams MK, Chames MC. Risk factors for the breakdown of perineal laceration repair after vaginal delivery. Am J Obstet Gynecol 2006; 195:755.
- Stock L, Basham E, Gossett DR, Lewicky-Gaupp C. Factors associated with wound complications in women with obstetric anal sphincter injuries (OASIS). Am J Obstet Gynecol 2013; 208:327.e1.
- INITIAL APPROACH
- Pain management
- Constipation prevention
- Resumption of sexual activity
- SYMPTOMS REQUIRING EVALUATION
- Severe pain
- - Infection
- - Separation
- Bulge or mass
- - Hematoma
- Abnormal discharge
- PHYSICAL EXAMINATION
- POST-DISCHARGE CARE
- LONG-TERM ISSUES
- Perineal pain or dyspareunia
- Incontinence or pelvic organ prolapse
- SPECIAL POPULATIONS
- Obstetric anal sphincter injury
- Female genital cutting (circumcision)
- SUMMARY AND RECOMMENDATIONS