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

OBJECTIVE: Explore women's subjective perceptions of healing from perineal tears in childbirth, with a particular focus on infection-related symptoms. METHODS: Women enrolled in a randomized-controlled-trial (ClinicalTrials, NCT02863874) were invited to complete a questionnaire at one- and eight-weeks postpartum. Infection-diagnosis was obtained separately through medical records. RESULTS: 1462 women (78%) responded, 4.5% had diagnose of perineal-tear infection. At one-week, primiparous diagnosed with infection reported significantly higher pain-scores and a greater frequency of redness, edema, and secretion compared to women without infection (P ≤ 0.001). After eight-weeks, differences in symptoms significantly persisted, aside from secretion, across both primipara and multipara (P < 0.045). Even after adjusting for type of tear, these results remained significant (P < 0.048). The NRS thresholds indicating infection were: ≥7 at one-week (AUC 0.8, 95% CI: [0.73-0.85]) and ≥ 3 at eight weeks (AUC 0.7, 95% CI: [0.66-0.81]). At one-week, the strongest predictor of infection was: NRS ≥ 7 coupled with redness (OR 17.3, 95% CI: [9.8-30.6]). In non-infected tears, the classification of the tear influenced pain perception and edema at both time points (P < 0.001). CONCLUSION: Infection in a perineal tear is clearly associated with higher levels of pain and, to a lesser extent, symptoms such as redness, swelling, and discharge, particularly evident in primipara. A pain-score of ≥7 combined with redness serves as the most reliable predictor of infection within the first week. The severity of non-infected tears influences pain intensity reporting; however, it is evident that the presence of infection takes precedence over the tear's severity in determining pain levels.