Ice pack induced perineal analgesia after spontaneous vaginal birth: Randomized controlled trial.

BACKGROUND: Ice-pack is widely used for alleviating postpartum perineal pain sustained after birth related perineal trauma. However, it lacks robust evidence on timing and frequency of applications, to ensure the effective and safe use of this therapy. AIMS: To evaluate if a 10min ice-pack application relieved postpartum perineal pain and if the analgesic effect was maintained for up to 2h. METHODS: A randomised controlled trial conducted from December 2012 to February 2013 with 69 primiparous women ≥18 years old, 6-24h postpartum, with perineal pain ≥3, who had not received anti-inflammatory medication or analgesics after childbirth, who were randomised to a single ice-pack application on the perineum for 10min or standard care. The primary and secondary outcomes were a reduction ≥30% in perineal pain intensity, immediately after the application and the maintenance of the analgesic effect for up to 2h, respectively. FINDINGS: Immediately post-intervention, the proportion of women whose perineal pain decreased ≥30% was significantly higher in the experimental group. Within 2h, there was no significant difference in the pain levels in both groups. Within 2h, for 61.9% and 89.3% of women in the experimental and control group, respectively, the perineal pain levels remained unchanged. For the remaining participants, perineal pain was increasing after an average time of 1h 45min and 1h 56min for the experimental and control groups, respectively. CONCLUSION: By applying an ice-pack for 10min to the perineum, effective pain relief is achieved, that is maintained for between 1h 45min and 2h.

Effect of low-level laser therapy on pain and perineal healing after episiotomy: A triple-blind randomized controlled trial.

BACKGROUND AND OBJECTIVE: Episiotomy is associated with perineal pain and healing complications. The low-level laser therapy (LLLT) reduces pain and inflammation and stimulates the healing process. This study aimed to assess the effect of LLLT on pain and perineal healing after an episiotomy. DESIGN/MATERIALS AND METHODS: A randomized, triple-blind, parallel clinical trial with 54 postpartum women who had a spontaneous birth with a right mediolateral episiotomy. The women were randomized into two groups: the experimental group (applications of LLLT n = 29) or the placebo group (simulated LLLT applications n = 25). Three sessions of real or sham irradiation were performed at 6-10 hours after normal birth, and the 2nd and 3rd applications were performed at 20-24 hours and 40-48 hours after the first session, respectively. Perineal pain was recorded using a Numeric Scale ranging from 0 to 10 (0 = absence and 10 = worst pain). Perineal healing was assessed using the redness, oedema, ecchymosis, discharge, and approximation (REEDA) scale. Both groups were assessed four times: in each of the three LLLT sessions and at 7-10 days after normal birth. The groups were compared using the Student's t, Mann-Whitney, and Chi-square tests. RESULTS: There was no significant difference between the groups regarding perineal healing after LLLT. The perineal pain scores were statistically higher in the experimental group in the first assessment and after the third LLLT. There was no significant difference between the groups related to the perineal pain scores 7-10 days after normal birth. CONCLUSION: The use of LLLT does not provide any benefit for treating postpartum perineal trauma using these specific protocol and parameters. Lasers Surg. Med. 49:181-188, 2017. © 2016 Wiley Periodicals, Inc.

Episiotomy healing assessment: Redness, Oedema, Ecchymosis, Discharge, Approximation (REEDA) scale reliability.

OBJECTIVE: to analyse the Redness, Oedema, Ecchymosis, Discharge, Approximation (REEDA) scale reliability when evaluating perineal healing after a normal delivery with a right mediolateral episiotomy. METHOD: observational study based on data from a clinical trial conducted with 54 randomly selected women, who had their perineal healing assessed at four time points, from 6 hours to 10 days after delivery, by nurses trained in the use of this scale. The kappa coefficient was used in the reliability analysis of the REEDA scale. RESULTS: the results indicate good agreement in the evaluation of the discharge item (0.75< Kappa ≥0.88), marginal and good agreement in the first three assessments of oedema (0.16< Kappa ≥0.46), marginal agreement in the evaluation of ecchymosis (0.25< Kappa ≥0.42) and good agreement regarding redness (0.46< Kappa ≥0.66). For the item coaptation, the agreement decreased from excellent in the first assessment to good in the last assessment. In the fourth evaluation, the assessment of all items displayed excellent or good agreement among the evaluators. CONCLUSION: the difference in the scores among the evaluators when applying the scale indicates that this tool must be improved to allow an accurate assessment of the episiotomy healing process.

[Care in a birth center according to the recommendations of the World Health Organization]. / Assistência em um centro de parto segundo as recomendações da Organização Mundial da Saúde.

Birth centers are maternal care models that use appropriate technology when providing care to birthing women. This descriptive study aimed to characterize intrapartum care in a freestanding birth center, in light of the practices recommended by the World Health Organization (WHO), with 1,079 assisted births from 2006 to 2009 in the Sapopemba Birth Center, São Paulo, Brazil. Results included the use of intermittent auscultation (mean=7 controls); maternal positions during delivery: semi-sitting (82.3%), side-lying (16.0%), other positions (1.7%), oral intake (95.6%); companionship (93.3%); exposure to up to three vaginal examinations (85.4%), shower bathing (84.0%), walking (68.0%), massage (60.1%), exercising with a Swiss ball (51.7%); amniotomy (53.4%), oxytocin use during the first (31.0%) and second stages of labor (25.8%), bath immersion (29.3%) and episiotomy (14.1%). In this birth center, care providers used practices recommended by the WHO, although some practices might have been applied less frequently.

[Reliability of an instrument to classify newborns according to care complexity]. / Confiabilidade de um instrumento para classificar o recém-nascido segundo a complexidade assistencial.

In most maternity units, the physician classifies, evaluates, and determines which unit will receive the newborn (NB) after birth. Evaluation occurs in the delivery room, taking into consideration the following factors: birth weight, gestational age, and behaviors that define the clinical picture and disease. This observational study evaluates the reliability of an NB classification instrument. The study was conducted at the nursery of a public hospital in São Paulo. Nine nurses applied the instrument to 63 NB, with two of the nurses working simultaneously in each of the nursery's five sectors. The Kappa level of agreement among the nurses was found to be excellent for most care areas (69.0%). It was concluded that there was a consensus and agreement among the nurses that the instrument was complete, easy to understand and applicable, but was very time consuming. The nurses recognize the instrument's importance for the allocation of professionals, organization, and care planning.

[Cryotherapy after childbirth: the length of application and changes in perineal temperature]. / Crioterapia no pós-parto: tempo de aplicação e mudanças na temperatura perineal.

We present a descriptive study based on the data from two clinical trials conducted at a maternity hospital in São Paulo, Brazil, in 2008 and 2009. This study aimed to describe perineal temperature after the application of an ice pack during the postpartum period. Three groups of 38 postpartum women (n=114 total) received an ice pack between 2 and 48 h after delivery. The results showed that after 10 minutes of cryotherapy, the mean perineal temperature varied between 13.3 degreeCand 15.3 degree"C, with a small reduction at the end of the 15- and 20-minute applications (2.4 degreeC and 2.7"C, respectively). Women who received cryotherapy for 10 minutes reported a cool sensation and pain relief; after a session of 15 or 20 minutes, the women reported anesthesia and numbness. In conclusion, an ice pack applied for 10 minutes reduced the perineal temperature to the recommended levels for analgesia (10-15 degreeC).

Factors associated with maternal intrapartum transfers from a freestanding birth centre in São Paulo, Brazil: a case control study.

OBJECTIVES: to identify factors associated with maternal intrapartum transfer from a freestanding birth centre to hospital. DESIGN: case-control study with retrospective data collection. PARTICIPANTS AND SETTINGS: cases included all 111 women transferred from a freestanding birth centre in Sao Paulo to the referral hospital, from March 2002 to December 2009. The controls were 456 women who gave birth in the birth centre during the same period who were not transferred, randomly selected with four controls for each case. METHODS: data were obtained from maternal records. Factors associated with maternal intrapartum transfers were initially analysed using a χ(2) test of association. Variables with p<0.20 were then included in multivariate analyses. A multiple logistic regression model was built using stepwise forward selection; variables which reached statistical significance at p<0.05 were considered to be independently associated with maternal transfer. FINDINGS: during the study data collection period, 111 (4%) of 2,736 women admitted to the centre were transferred intrapartum. Variables identified as independently associated factors for intrapartum transfer included nulliparity (OR 5.1, 95% CI 2.7-9.8), maternal age ≥35 years (OR 5.4, 95% CI 2.1-13.4), not having a partner (OR 2.8, 95% CI 1.5-5.3), cervical dilation ≤3 cm on admission to the birth centre (OR 1.9, 95% CI 1.1-3.2) and between 5 and 12 antenatal appointments at the birth centre (OR 3.8, 95% CI 1.9-7.5). In contrast, a low correlation between fundal height and pregnancy gestation (OR 0.3, 95% CI 0.2-0.6) appeared to be protective against transfer. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: identifying factors associated with maternal intrapartum transfer could support decision making by women considering options for place of birth, and support the content of appropriate information about criteria for admission to a birth centre. Findings add to the evidence base to support identification of women in early labour who may experience later complications and could support timely implementation of appropriate interventions associated with reducing transfer rates.

Perineal analgesia with an ice pack after spontaneous vaginal birth: a randomized controlled trial.

INTRODUCTION: This study evaluated the effectiveness of an ice pack applied for 20 minutes to alleviate perineal pain after spontaneous vaginal birth. METHODS: We conducted a randomized controlled trial at the Amparo Maternal Birth Center in São Paulo, Brazil. Study participants included 114 nulliparous women divided into 3 groups (n = 38 per group): experimental (ice packs on the perineum), placebo (water packs at set temperature), and control (no treatment). RESULTS: A numerical scale (0 to 10) was used for pain assessment. A comparison of the average pain at the beginning and after 20 minutes showed a significant reduction of pain (P < .001) in the 3 groups, and the experimental group had a lower average score for pain compared with the control group (1.6 versus 3.3, P = .032). DISCUSSION: The use of ice packs for 20 minutes was effective for perineal pain relief after vaginal birth.

[Transferring mothers from a free-standing birth center to a reference hospital]. / Remoções maternas da Casa do Parto de Sapopemba para hospital de referência.

The objective of this descriptive study was to characterize the transfers of mothers from the Sapopemba Birth Center to reference hospitals in São Paulo, from September 1998 to July 2008. The studied population was 229 cases of mother transfers. Data were obtained from medical records and record books of the transferred women. Descriptive analysis was performed. The transfer rate was 5.8% (5.5% in the intrapartum period and 0.3% in the postpartum period). Most women who were transferred to the hospital were nulliparous (78.6%). The most common reason for intrapartum transfers was fetal or pelvis abnormalities (22.6%), and abnormal placental detachment (50%) for women in the postpartum period. Some conditions such as nulliparity, cervical dilation at admission, rupture of the membranes and gestational age over 40 weeks were highlighted as important variables for studying the risk factors for mothers being transferred.

[Maternal and perinatal outcomes of an alongside hospital birth center in the city of São Paulo, Brazil]. / Resultados maternos e neonatais em centro de Parto Normal peri-hospitalar na cidade de São Paulo, Brasil.

The aim of this study was to describe the maternal and perinatal results of care in the alongside hospital birth center Casa de Maria (CPN-CM), located in the city of São Paulo. The random sample included 991 women and their newborns, attended between 2003 and 2006. The results showed that 92.2% of women had a companion of her choice during childbirth and the practices commonly used were shower or immersion bath (92.9%), amniotomy (62.6%), walking (47.6%), massage comfort (29.8%) and episiotomy (25.7%). Regarding newborns, 99.9% of them had Apgar scores =7 in the fifth minute, 9.3% received aspiration of the upper airway, no one needed to be intubated and 1.4% were removed to the hospital. The model of care in the CPN-CM provides maternal and perinatal outcomes expected for low obstetric risk women, and means a safe option and less interventionist model in normal childbirth.

[Clinical trial comparing three types of cryotherapy in nonpregnant women]. / Ensaio clcnico comparando três modalidades de crioterapia em mulheres não gravidas.

The objective of the present study was to compare three methods of cryotherapy in healthy non-pregnant women. This is a randomized controlled clinical trial that was conducted by 32 undergraduates of a private nursing college in the city of Sao Paulo, divided into three groups (iced water, soft ice, ice gel). The temperatures were verified (axillary, thigh, of the three ice packs) between zero and twenty minutes. The temperatures of the packs were the following: soft ice, from negative 9 degrees C to 2 degrees C; iced water, from 0 degrees C to 8 degrees C; and ice gel from negative 11 degrees C to 2 degrees C. There was a significant difference between the average thigh temperature values at 10 minutes (p = 0.007), 15 minutes (p = 0.003) and 20 minutes (p = 0.005). The gel was the most efficient cooling method. The three cryotherapy methods achieved the recommended temperature for analgesia and may be tested in women with perineal pain after childbirth.

Perineal muscle strength during pregnancy and postpartum: the correlation between perineometry and digital vaginal palpation.

Digital vaginal palpation performed during clinical practice can help diagnose urinary, intestinal and sexual disorders, while perineometry is more useful for performing perineal exercises with biofeedback. This study verifies whether there is a correlation between values of Pelvic Floor Muscle Strength (PFMS) obtained through perineometry performed with an electronic perineometer and through digital vaginal palpation using the Oxford scale. This is a prospective cohort study with 330 measurements carried out in 110 women. Data were collected from 2007 to 2008 in the health service system in Itapecerica da Serra, São Paulo, Brazil. Evaluations were carried out at three points in time: up to 12 weeks of pregnancy; between 36-40 weeks; and between 42-60 days postpartum. The Spearman coefficient indicated a strong positive correlation between the two evaluation methods for the three evaluations (p<0.0001). The conclusion is that both methods are valid for measuring PFMS during pregnancy and after delivery.

A randomised controlled trial evaluating the effect of immersion bath on labour pain.

OBJECTIVE: to evaluate the effect of an immersion bath on pain magnitude during the first stage of labour. DESIGN: a randomised controlled trial comparing the pain scores of bathing and non-bathing nulliparous women during birth was employed. SETTING: the study was conducted at the Normal Birth Center of Amparo Maternal, São Paulo, Brazil. PARTICIPANTS: 108 birthing women, with 54 women randomly assigned to each group. INTERVENTIONS: when the birthing women presented at 6-7 cm of cervical dilation, they were placed in an immersion bath for 60 mins. OUTCOME MEASURES: pain scores, using a behavioural pain scale and a numeric scale, were recorded at two evaluation time points: at 6-7 cm of cervical dilation and 1h after the first pain score evaluation. FINDINGS: at the first evaluation, on the behavioural scale, the means were 2.1 for both groups (p=0.914; 95% confidence intervals (CI) 1.9-2.3 for the control group and 2.0-2.2 for the experimental group). On the numeric scale, the means were 8.7 and 8.5 for the control and experimental groups, respectively (p=0.235; 95% CI 8.2-9.2 for the control group and 8.1-8.9 for the experimental group). At the second evaluation, the pain score means for both scales were statistically higher in the control group than in the experimental group. On the behavioural scale, the scores were 2.4 vs. 1.9, respectively, for the control and experimental groups (p<0.001; 95% CI 2.2-2.6 for the control group and 1.7-2.1 for the experimental group). On the numeric scale, the scores were 9.3 vs. 8.5, respectively, for the control and experimental groups (p<0.05; 95% CI 8.9-9.7 for the control group and 8.1-8.9 for the experimental group). CONCLUSIONS: mean labour pain scores in the control group were significantly higher than those in the experimental group. The present findings suggest that use of an immersion bath is a suitable alternative form of pain relief for women during labour.

[The partogram as an instrument to analyze care during labor and delivery]. / O Partograma como instrumento de análise da assistência ao parto.

Both the World Health Organization and the Brazilian Ministry of Health recommend using the partogram to follow labor. The objective of this study was to analyze the use of obstetrical interventions, the types of delivery, and perinatal outcomes according to zones I, II and III of the partogram. This cross-sectional study was performed with 233 low-risk pregnant women between December 2004 and March 2005 at a public maternity hospital located in the city of Itapecerica da Serra, in the state of São Paulo. Comparative analysis was performed using Chi-square and Fischer exact tests. The practices used in the different partogram zones with statistical significance of (p = 0.05) were: bath, movement and walking (zone-III); artificial rupture of the membranes (zone-II) and oxytocin (zone-I). Caesarean sections were performed on 24% of women in zone-III. The interventions occurred at a timely moment, indicating that the partogram is an instrument that can be used as a guide when adopting interventions during labor.

[Scientific production of Brazilian nurses on blood pressure measurement]. / Medida da pressão arterial e a produção científica de enfermeiros brasileiros.

In the previous issue of this journal the authors celebrated in an article the discovery of the Korotkoff sounds, in 1905, and presented the historical facts that determined the important role of the University of São Paulo's Nursing School (EEUSP) in the development of the oldest blood pressure research line in Brazilian Nursing: "Cuff Width Influence in Blood Pressure Measurement." This new article presents the scientific production derived from the studies carried out by nurses with a PhD from EEUSP during and after their doctoral programs in the area. The path each researcher followed in his/her group and laboratory is emphasized. The data presented is aimed at offering a number of qualitative and quantitative indicators that make possible to evaluate the impact of the research that they have carried out, as well as the development of knowledge in the area.

[Korotkoff sounds: development of the sphygmomanometry research at the Nursing School of the USP]. / Sons de Korotkoff: desenvolvimento da pesquisa em esfigmomanometria na Escola de Enfermagem da USP.

This article pays homage to Sergei Nicolai Korotkoff, for the centenary of the auscultatory method discovery. It refers to his discover of blood pressure auscultatory method in Russia, in 1905; presents the evidence that resulted in the development of sphygmomanometry studies in Brasil; describes the important contribution of the Nursing School of the University of São Paulo to the development of blood pressure measurement research; and analyses the results of the research field of "Cuff width influence in blood pressure measurement", created at the Nursing School of The University of São Paulo, in 1974. The scientific results of doctoral studies are presented, identifying the research groups that are contributing to defying knowledge in this area. The article demonstrates the consolidation of the results related to the initial doctoral program studies developed in the area. Confirmation of hypothesis in longitudinal studies is emphasized.

[Postnatal perineal edema assessment: agreement among observers]. / Avaliação do edema perineal no pós-parto: concordância entre observadores.

Perineal trauma produced during vaginal delivery is frequent, and there are no clinically validated evaluation scales available. The aim was to analyze the reliability of a tool to assess the vulvoperineal region during the postnatal period. This is an observational study conducted at the University Hospital of Universidade de São Paulo, Brazil. Thirty women with vaginal delivery were analyzed. The tool was built and evaluated in three stages: admission, 1-2, and 24-36 hours after delivery. Reliability analysis was carried out, and Kappa coefficient presented excellent, good, or marginal agreement to identify, respectively, 13, 20, and 13 parameters related to the pudendal chink, major and minor labia, clitoris, and perineal body. The conclusions were that the tool may be partially validated due to the reliability showed by the results, and that it must be modified, taking into consideration the individual characteristics of each woman, and changes that do not cause morbidity, which clinical evaluation is irrelevant.

[Type of delivery: women's expectations]. / Tipo de parto: expectativas das mulheres.

This descriptive and exploratory study was carried out through interviews with 221 puerperal women who gave birth in Sao Paulo State public maternities located within the capital. The purposes of the work were: 1. to identify the type of childbirth women expected to have--whether vaginal births or cesareans--and why; 2. to verify to what extent women's expectations corresponded to the type of birth they had; 3. to compare medical indications for c-sections with women's understanding of justifications they were given for this intervention. Data revealed that 74.7% of the women expected to have vaginal births and 25.3% expected to have cesarean sections. Vaginal birth, expected by 165 interviewees, occurred in 66.1% of these cases. Among women who expected having vaginal births, the most mentioned justification was that recuperation afterwards was faster. Among women who expected cesareans, the most mentioned justification was a previous c-section. The justifications presented by 61 women for having been submitted to c-sections did not coincide with medical indications for this intervention in 47.5% of the cases.