Healing-assessment tools for perineal and cesarean section wounds in postpartum women: A scoping review

Approximately 85% of women who undergo vaginal birth sustain childbirth-related perineal trauma. Worldwide, 21% of women give birth by cesarean section. These wounds therefore affect the vast majority of women after birth; however, there is a lack of validated tools to accurately identify women with abnormal wound healing in the postpartum period. Consequently, in clinical settings, validated wound-assessment tools are not generally used to assess wound healing in this population. We performed a scoping review to identify and characterize wound-assessment tools that have been used to determine the healing of childbirth-related wounds in existing research (to include women who experience perineal trauma or a cesarean section).

Medline, EMBASE, CINAHL, and Google Scholar were searched from inception to April 2024. Studies were included where wound-assessment tools were used to assess wound healing, after women had sustained either childbirth-related perineal trauma or a cesarean section, as an outcome of a primary research article. For studies that assessed wound healing in women with perineal trauma, this included all types of childbirth-related perineal trauma, sustained at spontaneous or assisted vaginal birth. Studies were eligible for inclusion where the wound-assessment tool was used at any time-point in the postpartum period.

There were 95 studies eligible for inclusion; 72 of which utilized wound-assessment tools for the assessment of healing after women sustained childbirth-related perineal trauma and 23 for women with cesarean section wounds. The REEDA tool (redness, oedema, ecchymosis, discharge, approximation) was used in 91 of the 95 studies, with the remainder using alternative wound-assessment tools, including the use of the ASEPSIS tool (additional treatment, serous discharge, erythema, purulent exudate, separation of deep tissues, isolation of bacteria, and length of inpatient stay).

There are limited wound-assessment tools to determine healing after women sustain childbirth-related wounds. The REEDA tool is the most commonly used in research settings. There is a clear need for the development of a clinically robust and inclusive wound- assessment tools, which comprehensively reflect the postpartum healing process among diverse populations.