Efficacy of hydrogel dressings with lidocaine in reducing inflammation of episiotomy wounds, postpartum stress and pain





pregnancy, quality of life, postpartum period, Hsp60, cytokines, episiotomy, hydrogel dressings


Episiotomy, like other surgical interventions, triggers inflammatory responses within the physiological context by engaging proinflammatory mediators such as interleukins, cytokines, and prostaglandins. The painful experiences associated with episiotomy have the potential to significantly impact both the physical and emotional well-being of the parturient, particularly when considering individual variables such as the extent of the incision and the presence of complicating factors. In the postpartum period, the presence of fear, anxiety, and anticipation of pain may contribute to heightened stress levels, thereby exerting a profound impact on the emotional state of the parturient. Emotional stress, in turn, has the capacity to modulate pain perception, amplifying the discomfort associated with the incision. Elevated concentrations of stress hormones can influence immune responsiveness and inflammatory cascades, subsequently affecting the intricate process of episiotomy healing.

Purpose - to examine determinants influencing the recovery of episiotomy wounds, encompassing inflammation markers, postpartum pain, and psychosocial stress.

Materials and methods. A prospective randomized study analyzed clinical, laboratory, and historical data from 123 primiparous patients with episiotomy wounds at Kyiv City Maternity Hospital No. 5 during 2021-2022. The study comprised a comparison group (63 patients receiving standard treatment) and a research group (60 patients additionally utilizing hydrogel dressings with lidocaine). Both groups underwent assessment for heat shock protein Hsp60 and bacterial homolog GroEl levels, serum interleukin-6 dynamics, cortisol levels, pain, and stress levels according to the Edinburgh Postnatal Depression Scale. Statistical analysis employed the Mann-Whitney U test and EZR v. 1.54 statistical package.

Results. No statistically significant differences were found in Hsp60 and GroEl levels, interleukin-6, cortisol, and pain levels after 24 hours between the comparison and research groups (p>0.05). However, interleukin-6 levels after 72 hours postpartum were 12.35 pg/ml (10.478-14.09) vs. 6.9 pg/ml (4.50-9.85); p<0.001; cortisol levels - 25.22 μg/dl (23.113-29.335) vs. 23.5 μg/dl (19.6-26.0), respectively; p<0.001. Pain levels by the visual analog scale after 72 hours postpartum were 4 (3-5) points vs. 3 (3-4) points; p<0.001; and at 10 days postpartum - 3 (2-3) points vs. 2 (2-3) points; p=0.010. Stress levels after 72 hours postpartum were 16 (13-19.75) points vs. 11.5 (9-15.5) points; p<0.001.

Conclusions. Grasping the intricate interplay of episiotomy, inflammation markers, stress, and pain is pivotal for delivering comprehensive postpartum care. The implementation of evidence-based strategies, such as personalized pain management protocols, psychological support, and systematic monitoring of inflammation markers, can significantly enhance women's well-being and render the postpartum recovery process more comfortable.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.


Albers L, Garcia J, Renfrew M, McCandlish R, Elbourne D. (1999). Distribution of genital tract trauma in childbirth and related postnatal pain. Birth. 26 (1): 11-17. https://doi.org/10.1046/j.1523-536x.1999.00011.x; PMid:10352050

Bączek G, Rychlewicz S, Sys D, Rzońca P, Teliga-Czajkowska J. (2022). Episiotomy for Medical Indications during Vaginal Birth - Retrospective Analysis of Risk Factors Determining the Performance of This Procedure. Journal of Clinical Medicine. 11 (15): 4334. https://doi.org/10.3390/jcm11154334; PMid:35893429 PMCid:PMC9368956

Bonior J, Jaworek J, Konturek S, Pawlik W. (2006). Leptin is the modulator of HSP60 gene expression in AR42J cells. Journal of Physiology and Pharmacology. 57: 135.

Campbell L, Saville CR, Murray PJ, Cruickshank SM, Hardman MJ. (2013). Local arginase 1 activity is required for cutaneous wound healing. Journal of Investigative Dermatology. 133 (10): 2461-70. https://doi.org/10.1038/jid.2013.164; PMid:23552798 PMCid:PMC3778883

Corwin EJ, Guo Y, Pajer K, Lowe N, McCarthy D, Schmiege S et al. (2013). Immune dysregulation and glucocorticoid resistance in minority and low income pregnant women. Psychoneuroendocrinology. 38 (9): 1786-1796. https://doi.org/10.1016/j.psyneuen.2013.02.015; PMid:23541234 PMCid:PMC4082825

Corwin EJ, Johnston N, Pugh L. (2008). Symptoms of postpartum depression associated with elevated levels of interleukin-1 beta during the first month postpartum. Biological research for nursing. 10 (2): 128-133. https://doi.org/10.1177/1099800408323220; PMid:18829596

Dalbye R, Gunnes N, Blix E, Zhang J, Eggebø T, Nistov Tokheim L et al. (2021). Maternal body mass index and risk of obstetric, maternal and neonatal outcomes: A cohort study of nulliparous women with spontaneous onset of labor. Acta obstetricia et gynecologica Scandinavica. 100 (3): 521-530. https://doi.org/10.1111/aogs.14017; PMid:33031566

Declercq E, Cunningham DK, Johnson C, Sakala C. (2008). Mothers' reports of postpartum pain associated with vaginal and cesarean deliveries: results of a national survey. Birth. 35 (1): 16-24. https://doi.org/10.1111/j.1523-536X.2007.00207.x; PMid:18307483

Dunkin CS, Pleat JM, Gillespie PH, Tyler MP, Roberts AH, McGrouther DA. (2007). Scarring occurs at a critical depth of skin injury: precise measurement in a graduated dermal scratch in human volunteers. Plastic and reconstructive surgery. 119 (6): 1722-1732. https://doi.org/10.1097/01.prs.0000258829.07399.f0; PMid:17440346

Dunn AB, Paul S, Ware LZ, Corwin EJ. (2015). Perineal injury during childbirth increases risk of postpartum depressive symptoms and inflammatory markers. Journal of midwifery & women's health. 60 (4): 428-436. https://doi.org/10.1111/jmwh.12294; PMid:26255803 PMCid:PMC4531382

Eason E, Labrecque M, Marcoux S, Mondor M. (2002). Anal incontinence after childbirth. Cmaj. 166 (3): 326-330.

Katon W, Russo J, Gavin A. (2014). Predictors of postpartum depression. Journal of women's health. 23 (9): 753-759. https://doi.org/10.1089/jwh.2014.4824; PMid:25121562

Klein MC, Gauthier RJ, Robbins JM, Kaczorowski J, Jorgensen SH, Franco ED et al. (1994). Relationship of episiotomy to perineal trauma and morbidity, sexual dysfunction, and pelvic floor relaxation. American journal of obstetrics and gynecology. 171 (3): 591-598. https://doi.org/10.1016/0002-9378(94)90070-1; PMid:8092203

Kleinridders A, Lauritzen HP, Ussar S, Christensen JH, Mori MA, Bross P, Kahn CR. (2013). Leptin regulation of Hsp60 impacts hypothalamic insulin signaling. The Journal of clinical investigation. 123 (11): 4667-4680. https://doi.org/10.1172/JCI67615; PMid:24084737 PMCid:PMC3809782

Lancaster CA, Gold KJ, Flynn HA, Yoo H, Marcus SM, Davis MM. (2010). Risk factors for depressive symptoms during pregnancy: a systematic review. American journal of obstetrics and gynecology. 202 (1): 5-14.; https://doi.org/10.1016/j.ajog.2009.09.007; PMid:20096252 PMCid:PMC2919747

Macarthur AJ, Macarthur C. (2004). Incidence, severity, and determinants of perineal pain after vaginal delivery: a prospective cohort study. American journal of obstetrics and gynecology. 191 (4): 1199-1204.; https://doi.org/10.1016/j.ajog.2004.02.064; PMid:15507941

Nish SA, Schenten D, Wunderlich FT, Pope SD, Gao Y, Hoshi N et al. (2014). T cell-intrinsic role of IL-6 signaling in primary and memory responses. eLife. 3: e01949. https://doi.org/10.7554/eLife.01949; PMid:24842874 PMCid:PMC4046568

Pei W, Tanaka K, Huang SC, Xu L, Liu B, Sinclair J et al. (2016). Extracellular HSP60 triggers tissue regeneration and wound healing by regulating inflammation and cell proliferation. NPJ Regenerative medicine. 1 (1): 1-11.; https://doi.org/10.1038/npjregenmed.2016.13; PMid:28936359 PMCid:PMC5605149

Prame Kumar K, Nicholls AJ, Wong CH. (2018). Partners in crime: neutrophils and monocytes/macrophages in inflammation and disease. Cell and tissue research. 371: 551-565. https://doi.org/10.1007/s00441-017-2753-2; PMid:29387942 PMCid:PMC5820413

Raison CL, Capuron L, Miller AH. (2006). Cytokines sing the blues: inflammation and the pathogenesis of depression. Trends in immunology. 27 (1): 24-31. https://doi.org/10.1016/j.it.2005.11.006; PMid:16316783 PMCid:PMC3392963

Raison CL, Miller AH. (2013). Malaise, melancholia and madness: the evolutionary legacy of an inflammatory bias. Brain, behavior, and immunity. 31: 1-8. https://doi.org/10.1016/j.bbi.2013.04.009; PMid:23639523 PMCid:PMC3678371

Treadwell T, Walker D, Nicholson B, Taylor M, Alur H. (2019). Treatment of pain in wounds with a topical long acting lidocaine gel. Chronic Wound Care Management and Research. 6: 117-121. https://doi.org/10.2147/CWCMR.S224092

Yang R, Masters AR, Fortner KA, Champagne DP, Yanguas-Casás N, Silberger DJ et al. (2016). IL-6 promotes the differentiation of a subset of naive CD8+ T cells into IL-21-producing B helper CD8+ T cells. Journal of Experimental Medicine. 213 (11): 2281-2291. https://doi.org/10.1084/jem.20160417; PMid:27670591 PMCid:PMC5068236

Yang W, Tao Y, Wu Y, Zhao X, Ye W, Zhao D et al. (2019). Neutrophils promote the development of reparative macrophages mediated by ROS to orchestrate liver repair. Nature communications. 10 (1): 1076. https://doi.org/10.1038/s41467-019-09046-8; PMid:30842418 PMCid:PMC6403250

Zhang Q, Raoof M, Chen Y, Sumi Y, Sursal T, Junger W et al. (2010). Circulating mitochondrial DAMPs cause inflammatory responses to injury. Nature. 464 (7285): 104-107. https://doi.org/10.1038/nature08780; PMid:20203610 PMCid:PMC2843437

Zunszain PA, Hepgul N, Pariante CM. (2012). Inflammation and depression. Behavioral neurobiology of depression and its treatment. 14: 135-151. https://doi.org/10.1007/7854_2012_211; PMid:22553073