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Hydrocortisone Cream to Reduce Perineal Pain after Vaginal Birth

A Randomized Controlled Trial

Manfre, Margaret BSN, RN, IBCLC; Adams, Donita BS, RNC; Callahan, Gloria RN; Gould, Patricia BSN, RNC; Lang, Susan RN, IBCLC; McCubbins, Holly BSN, RN; Mintz, Amy BSN, RN; Williams, Sommer RNC; Bishard, Mark Pharm-D; Dempsey, Amy MSN, RNC; Chulay, Marianne PhD, RN, FAAN

MCN: The American Journal of Maternal/Child Nursing: September/October 2015 - Volume 40 - Issue 5 - p 306–312
doi: 10.1097/NMC.0000000000000165
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Purpose: To determine if the use of hydrocortisone cream decreases perineal pain in the immediate postpartum period.

Study Design and Methods: This was a randomized controlled trial (RCT), crossover study design, with each participant serving as their own control. Participants received three different methods for perineal pain management at three sequential perineal pain treatments after birth: two topical creams (corticosteroid; placebo) and a control treatment (no cream application). Treatment order was randomly assigned, with participants and investigators blinded to cream type. The primary dependent variable was the change in perineal pain levels (posttest minus pretest pain levels) immediately before and 30 to 60 minutes after perineal pain treatments. Data were analyzed with analysis of variance, with p < 0.05 considered significant.

Results: A total of 27 participants completed all three perineal pain treatments over a 12-hour period. A reduction in pain was found after application of both the topical creams, with average perineal pain change scores of -4.8 ± 8.4 mm after treatment with hydrocortisone cream (N = 27) and -6.7 ± 13.0 mm after treatment with the placebo cream (N = 27). Changes in pain scores with no cream application were 1.2 ± 10.5 mm (N = 27). Analysis of variance found a significant difference between treatment groups (F2,89 = 3.6, p = 0.03), with both cream treatments having significantly better pain reduction than the control, no cream treatment (hydrocortisone vs. no cream, p = 0.04; placebo cream vs. no cream, p = 0.01). There were no differences in perineal pain reduction between the two cream treatments (p = .54).

Clinical Implications: This RCT found that the application of either hydrocortisone cream or placebo cream provided significantly better pain relief than no cream application.

Does hydrocortisone cream offer perineal pain relief after vaginal birth? A randomized controlled trial examines this clinical question in a study of postpartum women after vaginal birth.

Margaret Manfre is a Lactation Consultant, Mother Baby/GYN Unit, Lutheran Medical Center, Wheat Ridge, CO. She can be reached via e-mail at Margaret.manfre@sclhs.net

Donita Adams is a Staff Nurse, Mother Baby/GYN Unit, Lutheran Medical Center, Wheat Ridge, CO.

Gloria Callahan is a Staff Nurse, Mother Baby/GYN Unit, Lutheran Medical Center, Wheat Ridge, CO.

Patricia Gould is a Staff Nurse, Mother Baby/GYN Unit, Lutheran Medical Center, Wheat Ridge, CO.

Susan Lang is a Staff Nurse, Mother Baby/GYN Unit, Lutheran Medical Center, Wheat Ridge, CO.

Holly McCubbins is a Staff Nurse, Mother Baby/GYN Unit, Lutheran Medical Center, Wheat Ridge, CO.

Amy Mintz is a Staff Nurse, Mother Baby/GYN Unit, Lutheran Medical Center, Wheat Ridge, CO.

Sommer Williams is a Staff Nurse, Mother Baby/GYN Unit, Lutheran Medical Center, Wheat Ridge, CO.

Mark Bishard is a Pharmacist, Lutheran Medical Center, Wheat Ridge, CO.

Amy Dempsey is an OB Clinical Practice Specialist, Lutheran Medical Center, Wheat Ridge, CO.

Marianne Chulay is a Consultant, Clinical Research, Southern Pines, NC.

The authors declare no conflicts of interest.

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