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| Date: 05-29-2015 | HC# 121437-521 |
Re: Aloe and Calendula Aid in Episiotomy Wound Healing
Eghdampour
F, Jahdie F, Kheyrkhah M, Taghizadeh M, Naghizadeh S, Hagani H. The impact of
aloe vera and calendula on perineal healing after episiotomy in primiparous
women: a randomized clinical trial. J
Caring Sci. 2013;2(4):279-286.
An
episiotomy enlarges the perineum during childbirth. Perineal injury can cause
physical damage as well as emotional and psychological harm; possible
complications of delayed healing include bleeding, pain, and anxiety. Using
herbal medicines has been suggested to accelerate episiotomy wound healing.
Aloe (Aloe vera, Xanthorrhoeaceae) leaf and calendula (Calendula officinalis, Asteraceae) flower both possess
wound-healing and anti-inflammatory properties. The aim of this randomized
clinical trial was to compare the effects of aloe ointment, calendula ointment,
and Betadine® on episiotomy wound healing.
The
trial was conducted at Tehran Lolagar Hospital in Tehran, Iran from September
23 to December 21, 2010 and included 111 primiparous women who had undergone
episiotomy. After childbirth, the patients underwent examination of the
perineum and were monitored for 4 hours. Perineum healing was assessed using
the global REEDA (Redness, Edema, Ecchymosis, Drainage, and Approximation)
scale; reductions in REEDA scores indicate healing.
The
study intervention began 4 hours after episiotomy. Patients were randomly
assigned to 1 of the 3 following groups: aloe (n=37), calendula (n=37), or
control (n=37). Those in the aloe and calendula groups were instructed to clean
the episiotomy wound with water and apply 3 cc of ointment on the wound, with the
first application performed by the researcher and subsequent applications by patients
every 8 hours for 5 days. Specific contents of the ointments are not provided.
The control group followed the hospital's routine treatment for episiotomy,
i.e., cleansing with 2 spoons of Betadine in 4 glasses of water every 4 hours.
Of
the 111 patients, 11 were excluded from the final analysis due to inaccurate
use of ointment and 9 were lost to follow-up. The patients were asked to report
any sensitivity, infection, or other adverse side effects. No significant
demographic differences were noted among the 3 groups. Delivery (episiotomy
length, number of surface stitches, and head circumference of child) and
postpartum (mother's position during lactation, resumption of daily activities
after delivery, and body mass index of the mother) factors were similar.
The
mean total REEDA score 5 days after intervention indicated a statistically
significant difference among the 3 groups. The total score decreased from 4.32
to 1.62 in the aloe group, from 4.40 to 1.67 in the calendula group, and from
4.32 to 3.48 in the control group and was statistically significant between the
aloe and control groups (P<0.001) and between the calendula and control
groups (P<0.001). The difference between the aloe and calendula groups was
not significant.
After
5 days, the mean grade of redness differed significantly between the aloe
(0.59) and control (1.10) groups (P=0.006) and between the calendula (0.64) and
control groups (P=0.016). The redness scores did not differ significantly
between the aloe and calendula groups. For edema, the mean score was
statistically significant between the aloe (0.27) and control (0.64) groups
(P=0.004) and between the calendula (0.21) and control groups (P=0.001), but
not significantly different between the aloe and calendula groups. The
ecchymosis mean score was statistically different between the aloe (0.18) and control
(0.59) groups (P=0.009) and between the calendula (0.18) and control groups
(P=0.009). For wound discharge, no significant differences were reported among
the 3 groups or between the 2 experimental groups. The 3 groups differed
significantly in scores for approximation (P=0.005). The aloe (0.45) and
control (0.86) groups were significantly different (P=0.007), as well as the calendula
(0.56) and control groups (P=0.04). Again, no significant differences were
observed between the aloe and calendula groups.
None
of the patients reported any adverse side effects of the treatments.
These
results are consistent with those of a study that compared cleansing with Betadine
and water to water alone and another study on lavender (Lavandula spp., Lamiaceae) flower in the process of episiotomy
healing.1,2 Another study on the effect of turmeric (Curcuma longa, Zingiberaceae) ointment
on episiotomy healing had similar results for many of the REEDA scores but
found no significant difference between the turmeric and control groups for
edema.3
From
the findings reported here, the authors conclude, "Using aloe vera and calendula
ointment considerably increases the speed of episiotomy wound healing." As
ointment ingredients were not given, it is unclear if any additional ointment
ingredients could also have contributed to wound healing. The authors also
suggest that, because of the scarcity of studies and inconsistent findings,
more research is needed on alternative treatments, including aloe, calendula,
and lavender, to promote episiotomy wound healing.
—Shari Henson
References
1Tork Zahrani SH, Amir
Ali Akbari S, Valaei N. Comparison of the effect of Betadine and water in
episiotomy wound healing. [Article in Persian]. Feyz: Journal of Kashan University of Medical Sciences. 2002;5(20):80-85.
2Reference not
provided.
3Golmakani N, Rabiei
Motlagh E, Tara F, Assili J, Shakeri MT. The effects of turmeric (Curcuma longa L) ointment on healing of
episiotomy site in primiparous women. [Article in Persian]. Iranian Journal of Obstetrics, Gynecology,
and Infertility. 2009;11(4):29-38.
