episiotomy, and grade of perineal edema at 1 hour and 24 hours after spontaneous vaginal delivery were compared between the two groups.RESULTS: A total of 148 women who underwent vaginal delivery were recruited. No significant differences were observed between the HAase injection and control groups in the rates of perineal laceration (p=0.422). Perineal edema significantly decreased 24 hours after delivery in the women treated with perineal HAase injections, compared to women in the control group (p=0.008). The overall incidences of adverse events, such as redness of the injection site, infection, and wound dehiscence, were similar between the two groups.CONCLUSION: HAase injections in nulliparous women afforded no reductions in the rates of perineal lacerations and episiotomy. However, the use of perineal HAase injections did reduce perineal edema without severe adverse events.]]>
Edema ; Episiotomy ; Female ; Humans ; Hyaluronoglucosaminidase ; Incidence ; Lacerations ; Parity ; Wounds and Injuries

Puerperal genital hematomas are rare but life-threatening complications of obstetric emergencies. A pregnant patient (39 weeks) underwent a mediolateral episiotomy during a vaginal delivery. An afterbirth hematoma (approximately 20 cm in diameter) was evacuated, but the use of a vacuum-assisted wound closure system was applied after the sutures opened on the 7th postoperative day. On the 10th day of the vacuum-assisted closure (VAC) application, the wound was completely closed. VAC is an alternative treatment modality that can drain an infection and increase the proportion of granulation tissue in humid and irregular surfaces such as the perineum.
Emergencies ; Episiotomy ; Female ; Granulation Tissue ; Hematoma ; Humans ; Negative-Pressure Wound Therapy ; Perineum ; Sutures ; Wounds and Injuries

Background: One of the most common complications of episiotomy is infection. Most infections will resolve with local perineal care. Hence, episiotomy wound care is important. In preventing wound infection cleansing the vulva and external genital area with an antiseptic solution prior to, and several days after the procedure until the wound is healed is potentially beneficial. Objective: To compare the efficacy and patients? satisfaction of commercially prepared guava extract with povidone iodine as external genital antiseptic wash in women who underwent vaginal delivery and had episiorraphy in a Tertiary Hospital. Results: There were 248 women who underwent episiotomy and randomized to the guava leaf extract (n=122) and povidone-iodine (n=126) feminine wash groups. Episiotomy wound infection rate between guava (0.81%) and povidone iodine (2.38%) feminine wash, was not significantly different (p=0.33). Occurrence of adverse event was lower in the guava leaf extract (1, 0.81%) as compared to povidone iodine (4, 3.17%) feminine wash group, but is not statistically significant (p=0.19). The mean patient satisfaction score for the guava feminine wash is 4.4 which was significantly higher than the mean score of those in the povidone iodine feminine wash which is 3.6 (p< 0.001). Conclusion The efficacy in preventing episiotomy wound infection and rate of adverse reaction with the use of commercially prepared guava leaf extract is comparable with povidone iodine as an external genital antiseptic. With regards to patients? satisfaction and cost this was found to favor the use of commercially prepared guava leaf extract external genital wash
Human ; Female ; Episiotomy ; Wound Infection ; Guava Leaf Extract ; Povidone Iodine Feminine Wash ; Antiseptic External Genital Wash

Cavernous hemangiomas rarely involve the female genital tract. It is difficult to identify vascular malformations when these lesions are concealed in the vagina or deep vulva area. We present a rare case of vaginal cavernous hemangioma in a 30-year-old primiparous woman with an early severe postpartum hemorrhage (PPH) and delayed continuous bleeding from the episiotomy site. She was treated successfully with transarterial embolization of the left vaginal artery. To our knowledge, this is the first reported case of PPH caused by rupture of a vaginal hemangioma during vaginal delivery in English literature.
Adult ; Arteries ; Episiotomy ; Female ; Hemangioma ; Hemangioma, Cavernous* ; Hemorrhage ; Humans ; Postpartum Hemorrhage* ; Postpartum Period* ; Rupture ; Vagina ; Vascular Malformations ; Vulva

BACKGROUND: Episiotomy is a surgical incision of the perineum performed to widen the vaginal opening to facilitate the delivery of an infant. Bleeding is its common complication. A certain technique must be followed so as not to incur either dyspareunia, dehiscence or infection. Hence the application of policresulen solution during repair may minimize bleeding and facilitate better wound healing.

OBJECTIVE: To compare the operative and post-operative outcome between episiorraphy with and without application of policresulen solution during repair among puerperal patients admitted in a tertiary hospital.

METHODOLOGY: One hundred participants were randomized to two treatment groups. Those assigned to treatment A (n=50) underwent episiorrhaphy with policresulen solution application while those in treatment B (n=50) served as the control group. The main outcome measures were estimated blood loss, operative time and duration of wound healing.

RESULTS: There was a significantly shorter mean operative time with the participants in the Policresulen group (20.92 ± 0.90 minutes) as compared to the Control group (53.8 ± 1.79 minutes) with a P-value of < 0.001. Estimated mean blood loss was significantly lesser in the Policresulen group (195.2 ± 5.69 ml) than in the Control group (373.8 ± 16.14 ml) having a P-value of < 0.001. The duration of wound healing was also shorter among those in the Policresulen group (1.42 ± 0.09 weeks) than those in the Control group (2.14 ± 0.17 weeks), with a P-value of 0.003. A significantly greater proportion of participants had shorter operative time, lesser blood loss and shorter duration of wound healing in the policresulen group. (p-value < 0.005)

CONCLUSION: Policresulen solution application has a good hemostatic effect on the episiotomy wound hence shortened the operative time. It also has a good wound healing effect reflected by a shortened duration of wound healing of the episiotomy wound.

Human ; Female ; Adult ; Episiotomy ; Perineum ; Dyspareunia ; Surgical Wound ; Bleeding Time ; Blood Loss, Surgical ; Outcome Assessment (health Care)

Administration, Topical ; Cinnamomum zeylanicum ; Episiotomy ; methods ; Female ; Gels ; administration & dosage ; Humans ; Phytotherapy ; methods ; Plant Preparations ; administration & dosage ; Pregnancy

Scar sarcoidosis is a rare variant of cutaneous sarcoidosis that develops from an inactive scar. Scars due to various traumas including surgery, vaccines, cosmetic tattoos, and herpes zoster have been reported to be associated with sarcoidosis. Subcutaneous nodules are the most common clinical feature in Korean cutaneous sarcoidosis followed by papules and erythema. Non-caseating granulomas with a sparse lymphocytic infiltrate that are referred to as "naked granulomas" are the characteristic histopathological feature of cutaneous sarcoidosis. Two female patients aged 45 and 61 years presented with subcutaneous nodules on both blepharoplasty scars. A 46-year-old female also presented with subcutaneous nodules on scars on the palm and perineum obtained subsequent to trauma and episiotomy, respectively. Chest radiography showed bilateral hilar lymphadenopathy in the third patient. A diagnosis of sarcoidosis was made in all 3 patients based on clinical and histopathological findings with the exclusion of other granulomatous diseases. Herein, we report 3 cases of scar sarcoidosis arising from various types of traumatized skin.
Blepharoplasty ; Cicatrix* ; Diagnosis ; Episiotomy ; Erythema ; Female ; Granuloma ; Herpes Zoster ; Humans ; Lymphatic Diseases ; Middle Aged ; Perineum ; Radiography ; Sarcoidosis* ; Skin* ; Thorax ; Vaccines

PURPOSE: This study was done to examine current status of women's health nursing practicum and identify necessary core nursing skills in this practicum area. Moreover, one syllabus and evaluation sheets for women's health nursing clinical practicum at one university were reviewed. METHODS: A survey design was used with 81 educators who were teaching maternity or women's health nursing and its practicum. RESULTS: Most clinical sites for practicum were university hospitals (43.0%), women's hospitals (32.7%), or general hospitals (17.3%); but the majority (77.8%) of educators expressed difficulty in finding appropriate practicum places. Common teaching and learning methods were clinical guides for practicum (44.6%), e-learning content (30.2%), and simulation (23.6%). Core nursing skills for this practicum included assessment of stages of labor, preparation of uterine-fetal monitoring devices and interpretation of results, monitoring uterus and fetal activity, and performing Leopold's maneuver. For postpartum care, the following were included; postpartum fundal massage, assessment of breast engorgement, fundus height, and episiotomy sites, inserting urinary catheter, and teaching the use of patient-controlled analgesia. CONCLUSION: To improve the quality of clinical practicum, development of a clear course syllabus, standardized clinical guidebook, and core nursing skills is required and should be shared with all relevant nurse educators.
Analgesia, Patient-Controlled ; Breast ; Clinical Competence ; Education ; Episiotomy ; Female ; Fetal Movement ; Hospitals, General ; Hospitals, University ; Infant, Newborn ; Learning ; Massage ; Maternal-Child Nursing ; Nursing* ; Postnatal Care ; Postpartum Period ; Pregnancy ; Urinary Catheters ; Uterus ; Women's Health*

OBJECTIVE: This single blind, randomized, controlled trial investigated the efficacy of the use of guava leaves as hot steam and wash for postpartum wound healing in women who underwent normal spontaneous delivery with episiotomy.
METHODS: A total of 127 women aged 18 to 45, from 37 to 41 weeks AOG, served as subjects in this study. They were allocated to three treatments arms (guava group, antibiotic group and guava + antibiotic group) through block randomization. The guava group used a solution from boiled guava leaves as hot steam and wash tid for 7 days while the antibiotic group took amoxicillin 500 mg tid also for 7 days. The 3rd arm used both treatments. Outcomes included pain score (measured using Visual Analog Scale) and wound healing (measured using REEDA Scale) at 24 hours, 3 days and 7 days postpartum.
RESULTS: Showed that mean pain scores and mean REEDA scores of the women in the three groups at 24 hours, 3 days and 7 days postpartum were not significantly different. Likewise, the risk of wound dehiscence was not significantly different for the three treatment arms. Therefore, this study revealed that guava leaves extract used as hot steam and wash is as effective as the standard oral antibiotic intake for postpartum wound care but no additional benefit is derived from combining guava leaves and oral antibiotic.
CONCLUSION: Guava leaves used as hot steam and wash may be recommended for postpartum wound care after normal spontaneous  vaginal delivery with episiotomy.

Human ; Female ; Adult ; Episiotomy ; Psidium ; Steam ; Amoxicillin ; Anti-bacterial Agents ; Pain Measurement ; Delivery, Obstetric ; Wound Healing ; Postpartum Period

OBJECTIVES: The study aims to determine the degree of perineal trauma, postpartum perineal pain and fetal outcome in both groups using different maneuvers: "hands on" and "hands off" during the late second stage of labor among nulliparous women without episiotomy.
DESIGN: Prospective Randomized Research Study
SETTING: This study was conducted at the Labor / Delivery room complex from June 2012 to February 2013.
METHODS: In the second stage of labor, nulliparous women (120) giving birth were randomly allocated to "hands on"(the fetal head delivery was performed by using a towel-draped, gloved hand exerting forward pressure on the chin of the fetus through the perineum just in front of the coccyx) and "hands off" (the OB resident observed the parturient woman and did not touch perineum during the second stage of labor and the other hand exerts pressure superiorly against the occiput while the fetus was delivering) group. The two groups were compared as to their demographic characteristics, perineal trauma, postpartum pain and neonatal outcomes.
RESULTS: All women were nulliparous, term, without episiotomy and had similar demographic characteristics. Pain scores were collected in both groups after delivery. No significant difference in the postpartum pain scale values at 24 hours (p=0.134), 7 days (p=0.866), to 10 days (p=0.77) in both groups. Perineal trauma showed no significant association between laceration (p=0.212). Differences in APGAR Score as a measure of neonatal outcome was similar in both groups.
CONCLUSIONS: This study showed that perineal trauma, postpartum perineal pain and neonatal outcome between the "hands on" versus "hands off" have no significant difference. Therefore, it is not necessary to use "hands on" technique on all women in labor during the second stage of labor.

Human ; Female ; Adult ; Pregnancy ; Episiotomy ; Perineum ; Apgar Score ; Delivery Rooms ; Lacerations ; Coccyx ; Labor, Obstetric ; Delivery, Obstetric ; Term Birth ; Fetus ; Postpartum Period