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Which self-reported symptoms are associated with infection in a childbirth-related perineal tear?

Sonnichsen, K ; Zaigham, M LU orcid ; Isberg, P-E LU and Wiberg, N LU orcid (2026) In Sexual & Reproductive Healthcare 48.
Abstract

OBJECTIVE: Explore women's subjective perceptions of healing from perineal tears in childbirth, with a particular focus on infection-related symptoms.

METHODS: Women enrolled in a randomized-controlled-trial (ClinicalTrials, NCT02863874) were invited to complete a questionnaire at one- and eight-weeks postpartum. Infection-diagnosis was obtained separately through medical records.

RESULTS: 1462 women (78%) responded, 4.5% had diagnose of perineal-tear infection. At one-week, primiparous diagnosed with infection reported significantly higher pain-scores and a greater frequency of redness, edema, and secretion compared to women without infection (P ≤ 0.001). After eight-weeks, differences in symptoms significantly persisted,... (More)

OBJECTIVE: Explore women's subjective perceptions of healing from perineal tears in childbirth, with a particular focus on infection-related symptoms.

METHODS: Women enrolled in a randomized-controlled-trial (ClinicalTrials, NCT02863874) were invited to complete a questionnaire at one- and eight-weeks postpartum. Infection-diagnosis was obtained separately through medical records.

RESULTS: 1462 women (78%) responded, 4.5% had diagnose of perineal-tear infection. At one-week, primiparous diagnosed with infection reported significantly higher pain-scores and a greater frequency of redness, edema, and secretion compared to women without infection (P ≤ 0.001). After eight-weeks, differences in symptoms significantly persisted, aside from secretion, across both primipara and multipara (P < 0.045). Even after adjusting for type of tear, these results remained significant (P < 0.048). The NRS thresholds indicating infection were: ≥7 at one-week (AUC 0.8, 95% CI: [0.73-0.85]) and ≥ 3 at eight weeks (AUC 0.7, 95% CI: [0.66-0.81]). At one-week, the strongest predictor of infection was: NRS ≥ 7 coupled with redness (OR 17.3, 95% CI: [9.8-30.6]). In non-infected tears, the classification of the tear influenced pain perception and edema at both time points (P < 0.001).

CONCLUSION: Infection in a perineal tear is clearly associated with higher levels of pain and, to a lesser extent, symptoms such as redness, swelling, and discharge, particularly evident in primipara. A pain-score of ≥7 combined with redness serves as the most reliable predictor of infection within the first week. The severity of non-infected tears influences pain intensity reporting; however, it is evident that the presence of infection takes precedence over the tear's severity in determining pain levels.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Sexual & Reproductive Healthcare
volume
48
article number
101213
publisher
Elsevier
external identifiers
  • pmid:41962210
  • scopus:105035240757
ISSN
1877-5764
DOI
10.1016/j.srhc.2026.101213
language
English
LU publication?
yes
additional info
Copyright © 2026 The Author(s). Published by Elsevier B.V. All rights reserved.
id
54923be7-cab9-4572-8e7e-80736d3f0ff5
date added to LUP
2026-04-14 10:24:41
date last changed
2026-04-15 04:01:08
@article{54923be7-cab9-4572-8e7e-80736d3f0ff5,
  abstract     = {{<p>OBJECTIVE: Explore women's subjective perceptions of healing from perineal tears in childbirth, with a particular focus on infection-related symptoms.</p><p>METHODS: Women enrolled in a randomized-controlled-trial (ClinicalTrials, NCT02863874) were invited to complete a questionnaire at one- and eight-weeks postpartum. Infection-diagnosis was obtained separately through medical records.</p><p>RESULTS: 1462 women (78%) responded, 4.5% had diagnose of perineal-tear infection. At one-week, primiparous diagnosed with infection reported significantly higher pain-scores and a greater frequency of redness, edema, and secretion compared to women without infection (P ≤ 0.001). After eight-weeks, differences in symptoms significantly persisted, aside from secretion, across both primipara and multipara (P &lt; 0.045). Even after adjusting for type of tear, these results remained significant (P &lt; 0.048). The NRS thresholds indicating infection were: ≥7 at one-week (AUC 0.8, 95% CI: [0.73-0.85]) and ≥ 3 at eight weeks (AUC 0.7, 95% CI: [0.66-0.81]). At one-week, the strongest predictor of infection was: NRS ≥ 7 coupled with redness (OR 17.3, 95% CI: [9.8-30.6]). In non-infected tears, the classification of the tear influenced pain perception and edema at both time points (P &lt; 0.001).</p><p>CONCLUSION: Infection in a perineal tear is clearly associated with higher levels of pain and, to a lesser extent, symptoms such as redness, swelling, and discharge, particularly evident in primipara. A pain-score of ≥7 combined with redness serves as the most reliable predictor of infection within the first week. The severity of non-infected tears influences pain intensity reporting; however, it is evident that the presence of infection takes precedence over the tear's severity in determining pain levels.</p>}},
  author       = {{Sonnichsen, K and Zaigham, M and Isberg, P-E and Wiberg, N}},
  issn         = {{1877-5764}},
  language     = {{eng}},
  month        = {{04}},
  publisher    = {{Elsevier}},
  series       = {{Sexual & Reproductive Healthcare}},
  title        = {{Which self-reported symptoms are associated with infection in a childbirth-related perineal tear?}},
  url          = {{http://dx.doi.org/10.1016/j.srhc.2026.101213}},
  doi          = {{10.1016/j.srhc.2026.101213}},
  volume       = {{48}},
  year         = {{2026}},
}