Quality-assurance program for the improvement of morbidity during the first three postpartum days following episiotomy and perineal trauma

摘要

To evaluate implementation of an analgesic protocol for the management of pain caused by perineal trauma. Design: Quality-assurance program (QAP) with a closed loop audit. Setting: Postpartum ward in a referral perinatal centre. Population: Postpartum women with perineal trauma after vaginal delivery. Methods: A multimodal analgesic protocol was implemented (Phase 2) and data were collected before (Phase 1) and after implementation (at 1 year [Phase 3] and at 3 years [Phase 4]). Results: Phase 1 showed that perineal injury caused significant pain. When comparing Phases 3 and 4 to patients sutured in Phase 1, there was a significant decrease in immediate and worst pain scores on postpartum Days 1-3. More patients reported no difficulty in micturition and in defecation and more patients received analgesics compared to before protocol implementation. Conclusion: Introduction of an analgesic regimen for relief of postpartum perineal pain achieved a high degree of compliance and resulted in a sustained improvement in pain control and reduction of short-term morbidity.