Healing assessment tools for perineal and caesarean section wounds in postpartum women: a scoping review

<p dir="ltr">Introduction: Approximately 85% of women who undergo vaginal birth sustain childbirth-</p><p dir="ltr">related perineal trauma. Worldwide, 21% of women give birth by caesarean section. These</p><p dir="ltr">wounds therefore affect the vast majority of women after birth, however there are a lack of</p><p dir="ltr">validated tools to accurately identify women with abnormal wound healing in the postpartum</p><p dir="ltr">period. Consequently, in clinical settings, validated wound assessment tools are not generally</p><p dir="ltr">used to assess wound healing in this population. We performed a scoping review to identify</p><p dir="ltr">and characterise wound assessment tools that have been used to determine the healing of</p><p dir="ltr">childbirth-related wounds in existing research (to include women who experience perineal</p><p dir="ltr">trauma or a caesarean section).</p><p dir="ltr">Material and Methods: Medline, EMBASE, CINAHL and Google Scholar were searched</p><p dir="ltr">from inception to April 2024. Studies were included where wound assessment tools were</p><p dir="ltr">used to assess wound healing, after women had sustained either childbirth-related perineal</p><p dir="ltr">trauma or a caesarean section, as an outcome of a primary research article. For studies that</p><p dir="ltr">assessed wound healing in women with perineal trauma, this included all types of childbirth-</p><p dir="ltr">related perineal trauma, sustained at spontaneous or assisted vaginal birth. Studies were</p><p dir="ltr">eligible for inclusion where the wound assessment tool was used at any time-point in the</p><p dir="ltr">postpartum period.</p><p dir="ltr">Results: There were 95 studies eligible for inclusion; 72 of which utilised wound assessment</p><p dir="ltr">tools for the assessment of healing after women sustained childbirth-related perineal trauma</p><p dir="ltr">and 23 for women with caesarean section wounds. The REEDA tool (redness, oedema,</p><p dir="ltr">ecchymosis, discharge, approximation) was used in 91 of 95 studies, with the remainder</p><p dir="ltr">using alternative wound assessment tools, including use of the ASEPSIS tool (additional</p><p dir="ltr">treatment, serous discharge, erythema, purulent exudate, separation of deep tissues, isolation</p><p dir="ltr">of bacteria and length of inpatient stay).</p><p dir="ltr">Conclusions: There are limited wound assessment tools to determine healing after women</p><p dir="ltr">sustain childbirth-related wounds. The REEDA tool is the most commonly used in research</p><p>2</p><p dir="ltr">settings. There is a clear need for the development of a clinically robust and inclusive wound</p><p dir="ltr">assessment tool, which comprehensively reflects the postpartum healing process amongst</p><p dir="ltr">diverse populations</p>