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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Perineal tears often occur in vaginal delivery&#44; either spontaneously or through interventions such as an episiotomy&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">1&#44;2</span></a> Approximately 85&#37; of vaginal deliveries occur in perineal tears&#44; which is more common in primiparas &#40;90&#46;8&#37;&#41; than multiparas &#40;68&#46;8&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">1&#44;3</span></a> Perineal tears can cause bleeding&#44; infection and postpartum pain associated with the risk of depression&#44; dyspareunia and adversely affects the quality of life and sexual health&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">4&#44;5</span></a> The American College of Obstetricians and Gynecologists &#40;ACOG&#41; classifies perineal tears into four grades&#58; Grade 1st is lacerations to the perineal skin only&#44; Grade 2nd is lacerations to the perineal muscle&#44; but not including the anal sphincter&#44; Grade 3rd is lacerations to the anal sphincter muscle and Grade 4th is lacerations to the anal sphincter muscle anal sphincter and rectal epithelium&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Grades 1st and 2nd are about 50&#37; of the time at delivery&#46; In grade 1st&#44; because the tear is considered small&#44; repair by suturing may not be carried out depending on the doctor&#39;s advice&#44; while in grade 2nd&#44; it is recommended to do suturing&#46; Grades 3rd and fourth require more complex repairs and must be performed in the operating theater&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">1</span></a> Suturing the perineum can increase postpartum pain&#44; impacting daily life&#44; baby care&#44; and the mother&#39;s comfort&#44; so health workers must help mothers manage the pain they experience&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The purpose of this study will be to review several studies regarding the repair or treatment of perineal tears after vaginal delivery&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="par0020" class="elsevierStylePara elsevierViewall">This research is a literature review research from various articles in PubMed and ScienceDirect databases&#46; The keywords used in the search were &#8216;perineal tears&#44;&#8217; &#8216;perineal wound&#44;&#8217; and &#8216;perineal laceration&#8217;&#46; The search results found 8&#44;246 related articles on Pubmed and 25&#44;902 articles on ScienceDirect&#46; Furthermore&#44; the results will be filtered through the database by taking articles published in 2016&#8211;2021&#44; research articles&#44; and free full text from 124 Pubmed articles and 452 ScienceDirect articles filtered successfully&#46; The articles that have been obtained will be evaluated based on the inclusion criteria in this study&#44; namely&#58; 1&#41; not review articles&#44; 2&#41; the English language is available 3&#41; articles containing clinical trials or experiments for repair or treatment of perineal tears&#44; 4&#41; perineal tears discussed are grade 1st and second or episiotomy&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Articles considered appropriate will be reviewed by taking data&#44; journal title&#44; place and date of research&#44; objectives&#44; research samples&#44; research design&#44; the measurement used&#44; and research results&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Result</span><p id="par0030" class="elsevierStylePara elsevierViewall">Nine articles were found that matched the inclusion criteria&#46; Three articles examined the effect of this type of suture on perineal pain&#44; and another six discussed treatments to reduce the adverse effects of perineal tears&#8212;five articles using a visual analog scale in assessing postpartum perineal tears pain &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">This review found that the type&#47;technique of sutures used in repairing second-degree perineal tears or episiotomy affects the perineal pain felt by postpartum mothers&#46; The gold standard for repairing perineal wounds is to use absorbable sutures&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">15</span></a> However&#44; suturing the second-degree perineal skin tears can increase postpartum pain compared to unsutured or given surgical glue&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">4</span></a> The technique&#47;type of perineal suture can affect perineal pain&#44; where continuous sutures experience lower perineal pain&#44; better sexual activity&#44; and lower need for analgesia than mothers who are interrupted sutures&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">7&#44;9</span></a> This is due to the use of less material and also fewer knots&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">9</span></a> Post-suturing pain is caused by the inflammatory response of the sutures&#44; which can last until the sutures are removed or absorbed by the body&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">4</span></a> Leaving the perineal skin unsutured&#44; especially in grade 1st and grade 2nd perineal tears may reduce postpartum pain from day 14 to 6 weeks&#44; in addition to reducing the use of analgesia and the incidence of dyspareunia at three months postpartum&#44; but can leave gaping scars and long-term effects of this action is not yet known&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">5&#44;15&#44;16</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Postpartum care&#44; especially for mothers who have perineal tears&#44; needs to be considered to prevent chronic pain after delivery&#44; help mothers control pain&#44; prevent constipation and monitor urinary retention&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">5&#44;17</span></a> It is necessary to use various pharmacological and non-pharmacological methods and safe drugs for the mother to reduce postpartum pain or maternal morbidity due to perineal tears and the side effects of perineal tears&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">14</span></a> The provision of far-infrared radiation therapy&#44; capacitive-resistive radiofrequency therapy&#44; pelvic floor muscle training in early postpartum did not provide additional impact in reducing perineal pain or sexual function&#46; However&#44; radiofrequency therapy helps reduce perineal discomfort when walking&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a> Cold therapy on the perineum for 20<span class="elsevierStyleHsp" style=""></span>min can reduce perineal pain and increase the release of endorphins and stimulate the healing process&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">1&#44;5&#44;6&#44;13</span></a> Administration of TheresienOl &#40;a natural oil&#41; can reduce perineal wound pain and reduce swelling and erythema&#46; The described medicine acts by the following mechanism&#58; 1&#41; Hydrates tissues&#59; 2&#41; Reduce bacterial invasion and inflammation&#59; 3&#41; Stimulates migration and proliferation of fibroblastic and endothelial cells&#59; 4&#41; Stimulates epithelialization&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">14</span></a> The medications reviewed in this article do not cause any adverse health effects&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Sutures and technique&#47;suturing second-degree perineal tears or a postpartum episiotomy can affect perineal pain&#46; Cold gel pad therapy and treatment with natural oil on perineal wounds can affect perineal pain and wound healing&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Journal Title&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Author&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Place and date of the research&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Research design&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Research objectives&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Research samples&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">measurement used&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Research results&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Randomized Trial of 3 Techniques of Perineal Skin Closure During Second-degree Perineal Laceration Repair<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">4</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Carolyn W&#46; Swenson&#44; MD&#44; Lisa Kane Low&#44; CNM&#44; PhD&#44; Katherine M&#46; Kowalk&#44; BS1&#44; Dee E&#46; Fenner&#44; MD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">August 2014&#8211;April 2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A single-blind randomized controlled trial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">It compared the pain level and healing of grade II perineal tears that were sutured&#44; unsutured&#44; and using surgical glue&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Postpartum mothers who had 2nd-degree perineal tears&#46; Consisting of 14 mothers who had sutured&#44; 11 were not sutured&#44; and ten were given surgical glue to repair the perineal skin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The pain was assessed using the McGill Short Form&#44; 100-mm visual analog scale &#40;VAS&#41;&#44; and the Present Pain Index &#40;PPI&#41; on the first day&#44; 2 weeks&#44; 6 weeks and 3 months postpartum&#46;Assessment of perineal wound healing using Redness&#44; Edema&#44; Ecchymosis&#44; Drainage&#44; Approximation &#40;REEDA&#41; in the 6 postpartum week&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The level of pain felt by mothers whose perineal tears were sutured was higher than those without sutures or surgical glue&#46;There is no difference between healing time&#44; genital-self image&#44; intimate relationship&#44; and also postpartum depression&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Continuous versus discontinuous suture in perineal injuries produced during delivery in primiparous women&#58; a randomized controlled trial <a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Juan Miguel Mart&#237;nez-Galiano&#44; Beatriz Arredondo-L&#243;pez&#44; Leticia Molina-Garcia&#44; Ana Maria C&#225;mara-Jurado&#44; Eva Cocera-Ruiz3 and Miguel Rodr&#237;guez-Delgado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">southeast spain November 2016&#8211;May 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A single-blind randomized clinical trial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">To determine the difference between continuous and discontinuous sutures for pain&#44; other postpartum disorders&#44; and urinary&#47;feces incontinence&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Primiparous postpartum women who suffered second-degree perineal tears&#47;episiotomy were divided into two groups&#58; continuous suturing &#40;n&#58; 70&#41; and intermittent sutures &#40;n&#58; 64&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">pain assessment using the Verbal Rating Scale &#40;VRS&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mothers with continuous sutures experienced less pain&#44; less need for analgesia&#44; and less urinary incontinence than mothers who received discontinuous sutures&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Effect of far-infrared radiation on perineal wound pain and sexual function in primiparous women undergoing an episiotomy<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Li-Hua Huang&#44; Yu-Fen Lai&#44; Gin-Den Chen&#44; Maw-Sheng Lee&#44; Soo-Cheen Ng&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Taiwan&#44; May 2016&#8211;May 2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospective randomized study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">To determine the effect of Far-InfraRed &#40;FIR&#41; on perineal pain and sexual function&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Postpartum mothers who experienced second-degree perineal tears or episiotomy were divided into 2 groups&#46; The group was given Far-InfraRed &#40;FIR&#41; therapy 24<span class="elsevierStyleHsp" style=""></span>hours after delivery&#44; every 12<span class="elsevierStyleHsp" style=""></span>hours for 2 days &#40;n&#58; 18&#41;&#44; and the control group was not given the intervention &#40;n&#58; 22&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The pain scale was measured using the Visual Analogue Scale &#40;VAS&#41; at the first and sixth weeks postpartum and the Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire &#40;PISQ-12&#41; to evaluate the postpartum sexual function at 6 weeks&#44; 3 months&#44; and 6 months postpartum&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No mother complained of discomfort during thermal therapy or skin irritation and also no adverse effects after therapy&#46;Almost all mothers experienced mild pain 1 week after delivery&#44; and there was no significant difference between the FIR group or the groups in terms of pain level or sexual function&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Suture type used for perineal injury repair and sexual function&#58; a randomized controlled trial<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Juan Miguel Mart&#237;nez-Galiano&#44; Beatriz Arredondo-L&#243;pez&#44; Manuel Hidalgo-Ruiz&#44; Alicia Narvaez-Traverso&#44; Inmaculada Lopez-Mor&#243;n &#38; Miguel Delgado-Rodriguez&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Southeastern Spain&#44; November 2016&#8211;May 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Single-blind randomised clinical trial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">This study aims to determine the effect of the suture technique used on perineal wounds on the sexual function of women after childbirth&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Primiparous mothers who experienced second-degree perineal injuries or episiotomy during delivery consisted of 70 mothers who received continuous sutures and 64 who received Interrupted sutures&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Evaluation of sexual function using a valid scale from S&#225;nchez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">10</span></a>&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mothers who received continuous sutures had faster normal sexual intercourse&#44; easier orgasms&#44; sexual communication&#44; and better sexual satisfaction than mothers who received interrupted sutures&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Capacitive-resistive radiofrequency therapy to treat postpartum perineal pain&#58; A randomized study<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Florence Bretelle&#44; Chantal Fabre&#44; Marine Golka&#44; Vanessa Pauly&#44; Brimbelle Roth&#44; Vale&#769;rie Bechadergue&#44; dan Julie Blanc&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">France&#44; 1 June 2017&#8211;October 2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A double-blind single-center randomized controlled trial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">To evaluate the effect of capacitive-resistive radiofrequency therapy on perineal pain after vaginal delivery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60 Postpartum mothers with perineal tears or episiotomy consisting of 29 mothers who received radiofrequency therapy and 31 mothers who did not&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pain scale using Visual Analog Scale &#40;VAS&#41; at 2 days after therapy&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">There was no significant difference between the groups of mothers who were given radiofrequency therapy and not given to perineal pain or sexual activity&#46;In mothers who were given RF therapy&#44; there was a decrease in perineal discomfort when walking&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The Effects of Cold Application to the Perineum on Pain Relief After Vaginal Birth <a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Derya K&#46; Senol&#44; Ph&#46;D&#46;&#44; RN&#44; dan Ergul Aslan&#44; RN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Turkey&#44; the year 2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">An experimental randomized controlled study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">To determine the effectiveness of the cold gel pad against perineal pain after vaginal delivery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The total sample was 200 primiparous and multiparous pregnant women&#44; which consisted of 2 groups&#58; experimental group 100 and control group 100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Visual analog scale &#40;VAS&#41;&#44; and the postpartum comfort questionnaire &#40;PCQ&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">There was a significant decrease in perineal pain during the healing period and in daily activities after cold gel pad therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Early postpartum biofeedback-assisted pelvic floor muscle training in primiparous women with second-degree perineal laceration&#58; Effect on sexual function and lower urinary tract symptoms<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">12</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ting-Feng Wu&#44; Li-Hua Huang&#44; Yu-Fen Lai&#44; Gin-Den Chen&#44; dan Soo-Cheen Ng&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Taiwan&#44; December 2016-November 2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospective cohort study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">To determine the effect of pelvic floor muscle training with electromyography-biofeedback in early postpartum on sexual function and lower urinary tract symptoms&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Forty-five primiparous mothers after vaginal delivery suffered grade II perineal tears&#44; which consisted of 23 mothers in the pelvic floor muscle training group and 22 in the control group&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire &#40;PISQ-12&#41; and the Urinary Distress Inventory short-form questionnaire &#40;UDI-6&#41; immediately after delivery&#44; 6 weeks&#44; 3 months&#44; and 6 months postpartum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pelvic floor muscle training with EMG-BF did not relieve sexual function and lower urinary tract symptoms until 6 months postpartum&#46; This can be seen from the absence of significant differences between the intervention and control groups on sexual function and lower urinary tract symptoms&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Perineal Pain Management with Cryotherapy after Vaginal Delivery&#58; A Randomized Clinical Trial <a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#205;talo Morais&#44; Andr&#233;a Lemos&#44; Leila Katz2 Lorena Fernandes Rosendo de Melo&#44; Mariano Maia Maciel&#44; dan Melania Maria Ramos de Amorim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Brazil&#44; May 2012&#8211;October 2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A randomized&#44; double-blind clinical controlled study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">To determine the effect of ice therapy on perineal pain and vaginal edema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Eighty mothers&#44; after vaginal delivery consisting of 40 groups were given ice packs on the perineum for 20<span class="elsevierStyleHsp" style=""></span>minutes after 2<span class="elsevierStyleHsp" style=""></span>hours postpartum&#46; The administration was carried out 6 times with an interval of 60<span class="elsevierStyleHsp" style=""></span>minutes&#46; In the control group&#44; the mother was given a water compress with a temperature of 20<span class="elsevierStyleSup">0</span>-25<span class="elsevierStyleSup">0</span> with the same time and frequency as the ice pack group&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Combined scale for assessing pain &#40;CSAP&#41; for assessing pain in the perineum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">There was no significant difference in perineal pain between the groups given ice therapy and those that were not&#46;There was no significant difference in the incidence of perineal edema in the intervention and control groups&#46; Both groups show a downward trend&#46; At 24<span class="elsevierStyleHsp" style=""></span>hours post-pulmonary&#44; moderate&#47;severe edema was more common in the control group &#40;22&#46;5&#37;&#41; and in the intervention group &#40;7&#46;9&#41;&#44; but there was no statistically significant difference&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Postoperative management of postpartum perineal tears<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">14</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P&#46; Vasileva&#44; S&#46; Strashilov&#44; and A&#46; Yordanov&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bulgaria&#44; 1 January 2019-March 2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A prospective&#44; single-center&#44; cohort study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">To determine the effect of natural fats and pure herbal extracts &#40;Theresienol&#41; on the symptoms and the recovery in the early postpartum period&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Twenty women with per vias naturales birth&#44; with perineal trauma Women&#44; were divided into 10 people&#46; In the first group &#40;group A&#41;&#44; treatment with TheresienOl &#40;natural oil&#41; started on the second hour after birth with a frequency of three times a day&#46; The application was by topical rubbing of the oil on the affected area slowly &#40;throughout 30&#8211;60 s&#41; after the genital dressing&#46; In the other group &#40;group B&#41;&#44; no topical preparations were used&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pain symptomatology was assessed with a visual analog scale &#40;VAS&#41; for pain on the first&#44; the third&#44; and fifth day after birth&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TheresienOl therapy is effective against clinical symptoms and further monitoring and inclusion of new patients will show whether the risk of objective short-term and long-term complications is reduced&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Journal review on Perineal wound repair or care&#46;</p>"
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                    0 => array:1 [
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                            0 => "M&#46;J&#46; Arnold"
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                    0 => array:2 [
                      "doi" => "10.1186/1471-2393-2-1"
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                        "volumen" => "2"
                        "paginaInicial" => "1"
                        "paginaFinal" => "8"
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                      "titulo" => "Effect of far-infrared radiation on perineal wound pain and sexual function in primiparous women undergoing an episiotomy"
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                        0 => array:2 [
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                  ]
                  "host" => array:1 [
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                        "volumen" => "58"
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                  ]
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                          "etal" => true
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                        "paginaFinal" => "294"
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                        0 => array:2 [
                          "etal" => true
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.tjog.2020.11.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "Taiwan J Obstet Gynecol&#46;"
                        "fecha" => "2021"
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                        "link" => array:1 [
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            12 => array:3 [
              "identificador" => "bib0150"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Perineal Pain Management with Cryotherapy after Vaginal Delivery&#58; A Randomized Clinical Trial vaginal"
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                          "etal" => true
                          "autores" => array:1 [
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                    0 => array:1 [
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            13 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Postoperative management of postpartum perineal tears"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46; Vasileva"
                            1 => "S&#46; Strashilov"
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Care for perineal tears in vaginal delivery: An update for midwife
Asniah Hartinaha, Andi Nilawati Usmana,
Autor para correspondencia
, Sartinib, Nurhaedar Jafarc, M. Aryadi Arsyada, Risfa Yuliantyb, Heldayanti Sirendena, Jumiaty Nurungc
a Midwifery Study Program, Graduate School, Hasanuddin University, Indonesia
b Faculty of Pharmacy, Hasanuddin University, Indonesia
c Graduate School, Hasanuddin University, Indonesia
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Perineal tears often occur in vaginal delivery&#44; either spontaneously or through interventions such as an episiotomy&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">1&#44;2</span></a> Approximately 85&#37; of vaginal deliveries occur in perineal tears&#44; which is more common in primiparas &#40;90&#46;8&#37;&#41; than multiparas &#40;68&#46;8&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">1&#44;3</span></a> Perineal tears can cause bleeding&#44; infection and postpartum pain associated with the risk of depression&#44; dyspareunia and adversely affects the quality of life and sexual health&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">4&#44;5</span></a> The American College of Obstetricians and Gynecologists &#40;ACOG&#41; classifies perineal tears into four grades&#58; Grade 1st is lacerations to the perineal skin only&#44; Grade 2nd is lacerations to the perineal muscle&#44; but not including the anal sphincter&#44; Grade 3rd is lacerations to the anal sphincter muscle and Grade 4th is lacerations to the anal sphincter muscle anal sphincter and rectal epithelium&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Grades 1st and 2nd are about 50&#37; of the time at delivery&#46; In grade 1st&#44; because the tear is considered small&#44; repair by suturing may not be carried out depending on the doctor&#39;s advice&#44; while in grade 2nd&#44; it is recommended to do suturing&#46; Grades 3rd and fourth require more complex repairs and must be performed in the operating theater&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">1</span></a> Suturing the perineum can increase postpartum pain&#44; impacting daily life&#44; baby care&#44; and the mother&#39;s comfort&#44; so health workers must help mothers manage the pain they experience&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The purpose of this study will be to review several studies regarding the repair or treatment of perineal tears after vaginal delivery&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="par0020" class="elsevierStylePara elsevierViewall">This research is a literature review research from various articles in PubMed and ScienceDirect databases&#46; The keywords used in the search were &#8216;perineal tears&#44;&#8217; &#8216;perineal wound&#44;&#8217; and &#8216;perineal laceration&#8217;&#46; The search results found 8&#44;246 related articles on Pubmed and 25&#44;902 articles on ScienceDirect&#46; Furthermore&#44; the results will be filtered through the database by taking articles published in 2016&#8211;2021&#44; research articles&#44; and free full text from 124 Pubmed articles and 452 ScienceDirect articles filtered successfully&#46; The articles that have been obtained will be evaluated based on the inclusion criteria in this study&#44; namely&#58; 1&#41; not review articles&#44; 2&#41; the English language is available 3&#41; articles containing clinical trials or experiments for repair or treatment of perineal tears&#44; 4&#41; perineal tears discussed are grade 1st and second or episiotomy&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Articles considered appropriate will be reviewed by taking data&#44; journal title&#44; place and date of research&#44; objectives&#44; research samples&#44; research design&#44; the measurement used&#44; and research results&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Result</span><p id="par0030" class="elsevierStylePara elsevierViewall">Nine articles were found that matched the inclusion criteria&#46; Three articles examined the effect of this type of suture on perineal pain&#44; and another six discussed treatments to reduce the adverse effects of perineal tears&#8212;five articles using a visual analog scale in assessing postpartum perineal tears pain &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">This review found that the type&#47;technique of sutures used in repairing second-degree perineal tears or episiotomy affects the perineal pain felt by postpartum mothers&#46; The gold standard for repairing perineal wounds is to use absorbable sutures&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">15</span></a> However&#44; suturing the second-degree perineal skin tears can increase postpartum pain compared to unsutured or given surgical glue&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">4</span></a> The technique&#47;type of perineal suture can affect perineal pain&#44; where continuous sutures experience lower perineal pain&#44; better sexual activity&#44; and lower need for analgesia than mothers who are interrupted sutures&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">7&#44;9</span></a> This is due to the use of less material and also fewer knots&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">9</span></a> Post-suturing pain is caused by the inflammatory response of the sutures&#44; which can last until the sutures are removed or absorbed by the body&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">4</span></a> Leaving the perineal skin unsutured&#44; especially in grade 1st and grade 2nd perineal tears may reduce postpartum pain from day 14 to 6 weeks&#44; in addition to reducing the use of analgesia and the incidence of dyspareunia at three months postpartum&#44; but can leave gaping scars and long-term effects of this action is not yet known&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">5&#44;15&#44;16</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Postpartum care&#44; especially for mothers who have perineal tears&#44; needs to be considered to prevent chronic pain after delivery&#44; help mothers control pain&#44; prevent constipation and monitor urinary retention&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">5&#44;17</span></a> It is necessary to use various pharmacological and non-pharmacological methods and safe drugs for the mother to reduce postpartum pain or maternal morbidity due to perineal tears and the side effects of perineal tears&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">14</span></a> The provision of far-infrared radiation therapy&#44; capacitive-resistive radiofrequency therapy&#44; pelvic floor muscle training in early postpartum did not provide additional impact in reducing perineal pain or sexual function&#46; However&#44; radiofrequency therapy helps reduce perineal discomfort when walking&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a> Cold therapy on the perineum for 20<span class="elsevierStyleHsp" style=""></span>min can reduce perineal pain and increase the release of endorphins and stimulate the healing process&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">1&#44;5&#44;6&#44;13</span></a> Administration of TheresienOl &#40;a natural oil&#41; can reduce perineal wound pain and reduce swelling and erythema&#46; The described medicine acts by the following mechanism&#58; 1&#41; Hydrates tissues&#59; 2&#41; Reduce bacterial invasion and inflammation&#59; 3&#41; Stimulates migration and proliferation of fibroblastic and endothelial cells&#59; 4&#41; Stimulates epithelialization&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">14</span></a> The medications reviewed in this article do not cause any adverse health effects&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Sutures and technique&#47;suturing second-degree perineal tears or a postpartum episiotomy can affect perineal pain&#46; Cold gel pad therapy and treatment with natural oil on perineal wounds can affect perineal pain and wound healing&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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    "fechaRecibido" => "2021-06-28"
    "fechaAceptado" => "2021-07-30"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1456614"
          "palabras" => array:4 [
            0 => "Review"
            1 => "Perineal tears"
            2 => "Repair"
            3 => "Therapy"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The purpose of this study will be to review several studies regarding the repair or treatment of perineal tears after vaginal delivery&#46; This is expected to be an update for a midwife in daily caring&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Two electronic databases &#40;PubMed and Sciencedirect&#41; were searched to locate relevant literature about perineal tears&#47;wound&#47;laceration&#47;trauma that is published in 2016&#8211;2021&#46; 124 Pubmed articles and 452 ScienceDirect articles filtered successfully&#46; The articles that have been obtained will be evaluated based on the inclusion criteria in this study&#46; We summarize place and date&#44; objective&#44; design&#44; samples&#44; the measurement used&#44; and research results&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">9 articles were found that matched the inclusion criteria&#46; Three articles examined the effect of the type of suture on perineal pain&#44; and another 6 discussed therapy to reduce the adverse effects of perineal tears&#46; The therapies used are far-infrared radiation therapy&#44; capacitive-resistive radiofrequency therapy&#44; pelvic floor muscle training in early postpartum&#44; cold therapy&#44; and treatment with TheresienOl &#40;natural oil&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Sutures and technique&#47;suturing second-degree perineal tears or a postpartum episiotomy can affect perineal pain&#46; Cold gel pad therapy and treatment with natural oil on perineal wounds can affect perineal pain and wound healing&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Peer-review under responsibility of the scientific committee of the 3rd International Nursing&#44; Health Science Students &#38; Health Care Professionals Conference&#46; Full-text and the content of it is under responsibility of authors of the article&#46;</p>"
      ]
    ]
    "multimedia" => array:1 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
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        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Journal Title&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Author&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Place and date of the research&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Research design&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Research objectives&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Research samples&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">measurement used&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Research results&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Randomized Trial of 3 Techniques of Perineal Skin Closure During Second-degree Perineal Laceration Repair<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">4</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Carolyn W&#46; Swenson&#44; MD&#44; Lisa Kane Low&#44; CNM&#44; PhD&#44; Katherine M&#46; Kowalk&#44; BS1&#44; Dee E&#46; Fenner&#44; MD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">August 2014&#8211;April 2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A single-blind randomized controlled trial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">It compared the pain level and healing of grade II perineal tears that were sutured&#44; unsutured&#44; and using surgical glue&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Postpartum mothers who had 2nd-degree perineal tears&#46; Consisting of 14 mothers who had sutured&#44; 11 were not sutured&#44; and ten were given surgical glue to repair the perineal skin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The pain was assessed using the McGill Short Form&#44; 100-mm visual analog scale &#40;VAS&#41;&#44; and the Present Pain Index &#40;PPI&#41; on the first day&#44; 2 weeks&#44; 6 weeks and 3 months postpartum&#46;Assessment of perineal wound healing using Redness&#44; Edema&#44; Ecchymosis&#44; Drainage&#44; Approximation &#40;REEDA&#41; in the 6 postpartum week&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The level of pain felt by mothers whose perineal tears were sutured was higher than those without sutures or surgical glue&#46;There is no difference between healing time&#44; genital-self image&#44; intimate relationship&#44; and also postpartum depression&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Continuous versus discontinuous suture in perineal injuries produced during delivery in primiparous women&#58; a randomized controlled trial <a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Juan Miguel Mart&#237;nez-Galiano&#44; Beatriz Arredondo-L&#243;pez&#44; Leticia Molina-Garcia&#44; Ana Maria C&#225;mara-Jurado&#44; Eva Cocera-Ruiz3 and Miguel Rodr&#237;guez-Delgado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">southeast spain November 2016&#8211;May 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A single-blind randomized clinical trial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">To determine the difference between continuous and discontinuous sutures for pain&#44; other postpartum disorders&#44; and urinary&#47;feces incontinence&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Primiparous postpartum women who suffered second-degree perineal tears&#47;episiotomy were divided into two groups&#58; continuous suturing &#40;n&#58; 70&#41; and intermittent sutures &#40;n&#58; 64&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">pain assessment using the Verbal Rating Scale &#40;VRS&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mothers with continuous sutures experienced less pain&#44; less need for analgesia&#44; and less urinary incontinence than mothers who received discontinuous sutures&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Effect of far-infrared radiation on perineal wound pain and sexual function in primiparous women undergoing an episiotomy<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Li-Hua Huang&#44; Yu-Fen Lai&#44; Gin-Den Chen&#44; Maw-Sheng Lee&#44; Soo-Cheen Ng&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Taiwan&#44; May 2016&#8211;May 2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospective randomized study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">To determine the effect of Far-InfraRed &#40;FIR&#41; on perineal pain and sexual function&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Postpartum mothers who experienced second-degree perineal tears or episiotomy were divided into 2 groups&#46; The group was given Far-InfraRed &#40;FIR&#41; therapy 24<span class="elsevierStyleHsp" style=""></span>hours after delivery&#44; every 12<span class="elsevierStyleHsp" style=""></span>hours for 2 days &#40;n&#58; 18&#41;&#44; and the control group was not given the intervention &#40;n&#58; 22&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The pain scale was measured using the Visual Analogue Scale &#40;VAS&#41; at the first and sixth weeks postpartum and the Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire &#40;PISQ-12&#41; to evaluate the postpartum sexual function at 6 weeks&#44; 3 months&#44; and 6 months postpartum&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No mother complained of discomfort during thermal therapy or skin irritation and also no adverse effects after therapy&#46;Almost all mothers experienced mild pain 1 week after delivery&#44; and there was no significant difference between the FIR group or the groups in terms of pain level or sexual function&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Suture type used for perineal injury repair and sexual function&#58; a randomized controlled trial<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Juan Miguel Mart&#237;nez-Galiano&#44; Beatriz Arredondo-L&#243;pez&#44; Manuel Hidalgo-Ruiz&#44; Alicia Narvaez-Traverso&#44; Inmaculada Lopez-Mor&#243;n &#38; Miguel Delgado-Rodriguez&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Southeastern Spain&#44; November 2016&#8211;May 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Single-blind randomised clinical trial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">This study aims to determine the effect of the suture technique used on perineal wounds on the sexual function of women after childbirth&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Primiparous mothers who experienced second-degree perineal injuries or episiotomy during delivery consisted of 70 mothers who received continuous sutures and 64 who received Interrupted sutures&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Evaluation of sexual function using a valid scale from S&#225;nchez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">10</span></a>&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mothers who received continuous sutures had faster normal sexual intercourse&#44; easier orgasms&#44; sexual communication&#44; and better sexual satisfaction than mothers who received interrupted sutures&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Capacitive-resistive radiofrequency therapy to treat postpartum perineal pain&#58; A randomized study<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Florence Bretelle&#44; Chantal Fabre&#44; Marine Golka&#44; Vanessa Pauly&#44; Brimbelle Roth&#44; Vale&#769;rie Bechadergue&#44; dan Julie Blanc&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">France&#44; 1 June 2017&#8211;October 2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A double-blind single-center randomized controlled trial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">To evaluate the effect of capacitive-resistive radiofrequency therapy on perineal pain after vaginal delivery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60 Postpartum mothers with perineal tears or episiotomy consisting of 29 mothers who received radiofrequency therapy and 31 mothers who did not&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pain scale using Visual Analog Scale &#40;VAS&#41; at 2 days after therapy&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">There was no significant difference between the groups of mothers who were given radiofrequency therapy and not given to perineal pain or sexual activity&#46;In mothers who were given RF therapy&#44; there was a decrease in perineal discomfort when walking&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The Effects of Cold Application to the Perineum on Pain Relief After Vaginal Birth <a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Derya K&#46; Senol&#44; Ph&#46;D&#46;&#44; RN&#44; dan Ergul Aslan&#44; RN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Turkey&#44; the year 2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">An experimental randomized controlled study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">To determine the effectiveness of the cold gel pad against perineal pain after vaginal delivery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The total sample was 200 primiparous and multiparous pregnant women&#44; which consisted of 2 groups&#58; experimental group 100 and control group 100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Visual analog scale &#40;VAS&#41;&#44; and the postpartum comfort questionnaire &#40;PCQ&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">There was a significant decrease in perineal pain during the healing period and in daily activities after cold gel pad therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Early postpartum biofeedback-assisted pelvic floor muscle training in primiparous women with second-degree perineal laceration&#58; Effect on sexual function and lower urinary tract symptoms<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">12</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ting-Feng Wu&#44; Li-Hua Huang&#44; Yu-Fen Lai&#44; Gin-Den Chen&#44; dan Soo-Cheen Ng&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Taiwan&#44; December 2016-November 2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospective cohort study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">To determine the effect of pelvic floor muscle training with electromyography-biofeedback in early postpartum on sexual function and lower urinary tract symptoms&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Forty-five primiparous mothers after vaginal delivery suffered grade II perineal tears&#44; which consisted of 23 mothers in the pelvic floor muscle training group and 22 in the control group&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire &#40;PISQ-12&#41; and the Urinary Distress Inventory short-form questionnaire &#40;UDI-6&#41; immediately after delivery&#44; 6 weeks&#44; 3 months&#44; and 6 months postpartum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pelvic floor muscle training with EMG-BF did not relieve sexual function and lower urinary tract symptoms until 6 months postpartum&#46; This can be seen from the absence of significant differences between the intervention and control groups on sexual function and lower urinary tract symptoms&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Perineal Pain Management with Cryotherapy after Vaginal Delivery&#58; A Randomized Clinical Trial <a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#205;talo Morais&#44; Andr&#233;a Lemos&#44; Leila Katz2 Lorena Fernandes Rosendo de Melo&#44; Mariano Maia Maciel&#44; dan Melania Maria Ramos de Amorim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Brazil&#44; May 2012&#8211;October 2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A randomized&#44; double-blind clinical controlled study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">To determine the effect of ice therapy on perineal pain and vaginal edema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Eighty mothers&#44; after vaginal delivery consisting of 40 groups were given ice packs on the perineum for 20<span class="elsevierStyleHsp" style=""></span>minutes after 2<span class="elsevierStyleHsp" style=""></span>hours postpartum&#46; The administration was carried out 6 times with an interval of 60<span class="elsevierStyleHsp" style=""></span>minutes&#46; In the control group&#44; the mother was given a water compress with a temperature of 20<span class="elsevierStyleSup">0</span>-25<span class="elsevierStyleSup">0</span> with the same time and frequency as the ice pack group&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Combined scale for assessing pain &#40;CSAP&#41; for assessing pain in the perineum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">There was no significant difference in perineal pain between the groups given ice therapy and those that were not&#46;There was no significant difference in the incidence of perineal edema in the intervention and control groups&#46; Both groups show a downward trend&#46; At 24<span class="elsevierStyleHsp" style=""></span>hours post-pulmonary&#44; moderate&#47;severe edema was more common in the control group &#40;22&#46;5&#37;&#41; and in the intervention group &#40;7&#46;9&#41;&#44; but there was no statistically significant difference&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Postoperative management of postpartum perineal tears<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">14</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P&#46; Vasileva&#44; S&#46; Strashilov&#44; and A&#46; Yordanov&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bulgaria&#44; 1 January 2019-March 2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A prospective&#44; single-center&#44; cohort study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">To determine the effect of natural fats and pure herbal extracts &#40;Theresienol&#41; on the symptoms and the recovery in the early postpartum period&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Twenty women with per vias naturales birth&#44; with perineal trauma Women&#44; were divided into 10 people&#46; In the first group &#40;group A&#41;&#44; treatment with TheresienOl &#40;natural oil&#41; started on the second hour after birth with a frequency of three times a day&#46; The application was by topical rubbing of the oil on the affected area slowly &#40;throughout 30&#8211;60 s&#41; after the genital dressing&#46; In the other group &#40;group B&#41;&#44; no topical preparations were used&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pain symptomatology was assessed with a visual analog scale &#40;VAS&#41; for pain on the first&#44; the third&#44; and fifth day after birth&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TheresienOl therapy is effective against clinical symptoms and further monitoring and inclusion of new patients will show whether the risk of objective short-term and long-term complications is reduced&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Journal review on Perineal wound repair or care&#46;</p>"
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
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            0 => array:3 [
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                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Goh"
                            1 => "D&#46; Goh"
                            2 => "H&#46; Ellepola"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Perineal tears &#8211; A review"
                        "fecha" => "2018"
                        "volumen" => "47"
                        "paginaInicial" => "35"
                        "paginaFinal" => "38"
                      ]
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            1 => array:3 [
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                    0 => array:1 [
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                          "etal" => true
                          "autores" => array:1 [
                            0 => "H&#46; Kwon"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
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                        "fecha" => "2020"
                        "volumen" => "61"
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              ]
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            2 => array:3 [
              "identificador" => "bib0100"
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                          "autores" => array:1 [
                            0 => "M&#46;H&#46; Jansson"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Risk factors for perineal and vaginal tears in primiparous women &#8211; the prospective POPRACT-cohort study"
                        "fecha" => "2020"
                        "volumen" => "0"
                        "paginaInicial" => "1"
                        "paginaFinal" => "14"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Randomized Trial of 3 techniques of perineal skin closure during second-degree perineal laceration repair"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:1 [
                            0 => "C&#46;W&#46; Swenson"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Midwifery Womens Heal&#46;"
                        "fecha" => "2019"
                        "volumen" => "64"
                        "paginaInicial" => "567"
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            4 => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obstetric Lacerations&#58; Prevention and Repair"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;J&#46; Arnold"
                            1 => "U&#46; Services"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2021"
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            5 => array:3 [
              "identificador" => "bib0115"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effects of cold application to the perineum on pain relief after vaginal birth"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;K&#46; Senol"
                            1 => "D&#46; Ph"
                            2 => "E&#46; Aslan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Asian Nurs Res &#40;Korean Soc Nurs Sci&#41;"
                        "fecha" => "2017"
                        "volumen" => "11"
                        "paginaInicial" => "276"
                        "paginaFinal" => "282"
                      ]
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                  ]
                ]
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              "identificador" => "bib0120"
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                      "titulo" => "Continuous versus discontinuous suture in perineal injuries produced during delivery in primiparous women&#58; a randomized controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:1 [
                            0 => "J&#46;M&#46; Mart&#237;nez-galiano"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1471-2393-2-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "BMC Pregnancy Childbirth"
                        "fecha" => "2019"
                        "volumen" => "2"
                        "paginaInicial" => "1"
                        "paginaFinal" => "8"
                        "link" => array:1 [
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                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0125"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of far-infrared radiation on perineal wound pain and sexual function in primiparous women undergoing an episiotomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:1 [
                            0 => "L&#46; Huang"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.tjog.2018.11.013"
                      "Revista" => array:6 [
                        "tituloSerie" => "Taiwan J Obstet Gynecol&#46;"
                        "fecha" => "2019"
                        "volumen" => "58"
                        "paginaInicial" => "68"
                        "paginaFinal" => "71"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30638484"
                            "web" => "Medline"
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                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0130"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Suture type used for perineal injury repair and sexual function&#58; a randomised controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:1 [
                            0 => "J&#46; Miguel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Sci Rep&#46;"
                        "fecha" => "2020"
                        "paginaInicial" => "1"
                        "paginaFinal" => "7"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Design and validation of the questionnaire on women&#39;s sexual function &#40;WSF&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:1 [
                            0 => "F&#46; S&#225;nchez"
                          ]
                        ]
                      ]
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