What does reeda stand for

At the second evaluation, the mean values of the ecchymosis, discharge and coaptation items were similar. For the oedema and hyperaemia items, the difference ranged from 0.

The difference in the mean total score was 0. The third evaluation revealed that the mean of the score of each item analysed by the main researcher and by the judge were similar to each other, except for hyperaemia. This similarity also occurred with the mean total score Table 3. At the fourth assessment, the results were obtained from the evaluation of 43 women, since that 11 postpartum women were lost in the follow-up.

Nine of them did not attend the follow-up visit, and two women used an anti-inflammatory solution on the perineum.

The items hyperaemia, oedema, ecchymosis and discharge had the same mean values in this assessment. The only difference was found in the evaluation of the coaptation item. The mean total score of the items was similar in this assessment Table 3. The Kappa coefficient value, which was used to analyse the agreement between the evaluators in the four stages, displayed very good, good and marginal agreement in 8, 7 and 5 item evaluations, respectively.

Discharge was the only item that displayed very good agreement for all evaluations. Oedema displayed good and marginal agreement for the first three assessments.

Conversely, the agreement for ecchymosis was mainly marginal. At the fourth assessment from 7 to 10 days , all items displayed excellent or good agreement among the evaluators Table 4. Adopting protocols with well-defined criteria is essential for systematically assessing and treating injury. This study aimed to assess the inter-observer reliability of the REEDA scale as a tool for the quantitative assessment of perineal healing after episiotomy.

The excellent agreement obtained in the evaluation of the discharge item is related to the low frequency of this event in the women of this sample.

Only two women experienced this event at the third or fourth assessment. When the elements of the sample are very similar regarding the studied event, it is more difficult for the instrument to reliably indicate different item degrees The smallest REEDA score for the item coaptation was observed in the first postpartum hours first, second and third assessments , indicating the maximum approximation of the wound edges.

The presence of the suture stitches, in these occasions, ensured the coaptation of the wound edges. At the fourth assessment, performed at 7 to 10 days after the birth, the suture material has been fully absorbed.

In this healing stage, it is expected that the perineal tissue is undergoing a proliferation process 6 , however the perineal wound may be partially or totally dehisced, involving superficial tissues such skin or as the deeper layers, such as muscles.

The inability of professionals to differentiate normal and abnormal wound healing, associated with the millimetre dimensions of REEDA scale to assess the approximation of the wound edges might justify the lower value of the Kappa coefficient observed in this assessment.

In the hyperaemia item, difficulties when applying the REEDA scale arise from the fact that this item is bilaterally assessed. In clinical practice, hyperaemia might be observed in only one side of the incision. Consequently, in this study, this item was assessed only regarding its area when a unilateral occurrence prevented a full evaluation.

The marginal agreement in the oedema and ecchymosis evaluation, obtained in this study, highlights the complexity of the application of the REEDA scale resulting from the precision with which they are assessed. The ecchymosis can occur discretely. Moreover, it might be difficult to distinguish between the occurrence of hyperaemia and ecchymosis, even when the evaluators are trained 7.

The difficulties in defining and measuring the perineal oedema are related to the fact that the REEDA scale classifies its extension from one to two centimetres from the incision. This measurement can be confused depending on the protrusions of tissue resulting from tight stitches of the suture. Moreover, oedema is assessed only regarding the width from the edge of the incision, not the length and depth of the tissue that presents induration 7.

Other studies also highlight the difficulty of identifying and assessing perineal oedema and ecchymosis in clinical practice with the use of other measurement instruments. In a study 20 carried out to develop and validate an instrument to assess the severity of perineal trauma based on the degrees of oedema and ecchymosis, twenty women, evaluated up to 48 h after episiotomy, were divided into two groups and assessed by two experienced and two newly trained midwives.

The instrument consisted of pictures that represented different degrees of oedema and ecchymosis, classified using the categories none, mild, moderate and severe, followed by the application of a categorical scale. The Kappa coefficient displayed excellent reliability among the examiners 0. However, in 9 cases there was difficulty in the oedema classification, and there was difficulty in 4 cases of ecchymosis. The less experienced professionals displayed more uncertainty in the application of the scale The data of our study indicate that the REEDA scale scores also had better agreement among the evaluators when used at the follow-up visit, when the items with less agreement hyperaemia, oedema and ecchymosis were no longer present.

These local inflammatory signs are expected in an early phase of the healing process and decrease with the evolution of local reactions and absorption of the suture material. After nearly two weeks, the cell matrix formation and tissue remodelling is generally complete, even though this process can take several months These results indicate the need for further research to redefine the criteria for evaluating those items.

Limitations of this study included a small sample size, which was not calculated to detect a difference when comparing the evaluation of the judges. Notwithstanding, sample was enough to identify the items for which there was a low inter-rater agreement.

The assessments were carried out by several professionals, which increase the variability of the data but it also allows to verify the use of the REEDA scale in a clinical setting. Of the five items of the REEDA scale, the hyperaemia, secretion and coaptation of the edge wound items displayed more consistent ratings. The evaluation of the oedema and ecchymosis items, however, were unreliable.

The scale offers a better evaluation of perineal healing when applied from 7 to 10 days after the delivery, when the items of lower correlation are no longer present. Though the scale has a very detailed classification of the items, the evaluation criteria are not clear, which impairs its application. The difference in scores between evaluators in the scale application indicates that this instrument is not accurate and should be enhanced to facilitate data recording and the systematic evaluation of the episiotomy healing process.

A reliable instrument for assessing perineal healing is valuable to nurse-midwives, midwives and other caregivers, as a concise evaluation tool may help facilitate measures to improve perineal care. National Center for Biotechnology Information , U. Rev Lat Am Enfermagem. Author information Article notes Copyright and License information Disclaimer.

Escola de Enfermagem Av. Received Dec 13; Accepted Sep Copyright notice. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. For the stitches that you can see, make sure to watch for any signs of infection.

These signs include if the incision area is red, swollen, or weeping pus; or if you have a fever. The proctologic knee—chest or prone jackknife position is the preferred position in which to examine the perineum and rectum properly.

In this position , the patient can easily undergo further studies such as anoscopy and sigmoidoscopy because of easier access to the anorectum. For wounds healing by primary intention, key assessment factors include the approximation of wound margins the edges of the wound fit together snugly , drainage a closed incision should not have any drainage , evidence of infection and the presence of a palpable healing ridge along the incision by the fifth.

A higher score indicates a greater level of tissue trauma. Always wipe front to back. Use an antibacterial sanitizer on your hands prior to cleaning the perineal area to prevent infecting the wound with your hand. Change your pad every two to four hours. If you end up having a more severe tear or an episiotomy , the same methods that work for regular tears will help you heal : sitz baths, ice packs, witch hazel and anesthetic sprays.

Simply exposing the area to air, too, can help it heal more quickly and with less pain. Regardless of whether a tear happens on its own or as a result of an episiotomy , it's not even possible to make a vagina tighter with stitching, according to OBGYN Jesanna Cooper, MD. Some women may not need any stitches but many do. An episiotomy is a cut performed by the midwife or doctor to increase the diameter of the vaginal opening, allowing the baby's head to pass.

Thankfully, in most women, the tissue heals over time and they suffer no long-term consequences from the birth trauma. An episiotomy is a surgical incision, usually made with sterile scissors, in the perineum as the baby's head is being delivered. In other cases, the episiotomy is performed by making a diagonal incision across the midline between the vagina and anus called a mediolateral incision. Episiotomies have the following potential side effects: Infection.

Extended healing time. An episiotomy is usually repaired within an hour after delivery. The incision may bleed quite a bit at first, but should stop once your doctor closes the wound with sutures. After having an episiotomy , it's normal to feel pain around the incision site for two to three weeks.

The anatomic structures involved in a mediolateral episiotomy include the vaginal epithelium, transverse perineal muscle, bulbocavernosus muscle , and perineal skin. An episiotomy is a surgical incision, usually made with sterile scissors, in the perineum as the baby's head is being delivered. In other cases, the episiotomy is performed by making a diagonal incision across the midline between the vagina and anus called a mediolateral incision.

The procedure. If you have an episiotomy , your doctor will give you a shot of local anesthetic to numb the area before cutting, unless the area is already numb from your epidural. After your baby is born, your doctor will stitch the episiotomy and other tears with dissolvable sutures.

The episiotomy tradition For years, an episiotomy was thought to help prevent more extensive vaginal tears during childbirth — and heal better than a natural tear. Today, however, research suggests that routine episiotomies don't prevent these problems after all. An episiotomy is a surgical cut made through the muscular area between the vagina and the anus also called perineum. It is made by a doctor or midwife in order to make the opening wider, and possibly to prevent a more serious tear.

Episiotomies have the following potential side effects: Infection. Extended healing time. Painful scarring that might require a period of abstinence from sexual intercourse. Future problems with incontinence. Local anesthesia is injected into a specific area to provide pain relief during labor. It is also given near the end of birth for an episiotomy , to relieve the discomfort of the perineum stretching and also after birth to repair tears and episiotomies.