How do you use dermoplast after birth?

A 32 year old named G1P0 presents at 39 weeks 2 days to labor and deliver with pain.On arrival, the exam is 5 cm dilated, 80% effaced, and 1+ station.She delivered a baby with APGARS of 8 and 9 after seven hours.The delivery was complicated by a second degree perineal laceration that was repaired in standard fashion.The Standard postpartum orderset was chosen by the physicians.The order set includes an order for ice packs to be placed on the perineum and for Epifoam every three hours.

The hospital's standard order set includes an order for icepacks.

For a hospital with around 3000 vaginal deliveries per year, the cost savings would be around $238,000.

A review looked at how to treat perineal pain after a baby is born.They did not find a decreased need for additional analgesia in the lidocaine group despite an article showing a decrease in need.One study that was cited in the review found that women who were given Epifoam or Lidocaine had lower pain values than placebo.Their conclusion was that there was no compelling evidence for the effectiveness of analgesia for perineal pain.The use of traditional regimes including Epifoam and ice packs was found to be inferior to maternity gel packs.

Epifoam is fifteen times more expensive than the base cost of Dermoplast.A quality improvement study showed that physicians had a poor knowledge of the cost of epifoam.The prechecked order for Epifoam was removed from the standing orders because of the cost difference.If desired, Epifoam could be ordered.The utilization of Epifoam decreased after this project.The projected cost savings at the main hospital campus were favored by Dermoplast.Epifoam was removed from the formulary due to cost.The trial focused on the reduction of pain with hydrocortisone cream, placebo cream and no cream.Each patient had her own control in this cross-over trial, as each of the creams and no cream were applied to a witch hazel pad that was used for application.There was a significant reduction in pain when cream was applied, but there was no difference in whether the cream contained hydrocortisone or not.This supports the institution's decision to remove Epifoam from formulary as the addition of Pramoxine and Hydrocortisone did not increase pain relief.

According to a study, ice packs help to numb superficial tissue and reduce pain.In Brazil, ice packs placed within hours of delivery provided significant pain relief.The correlation between pain relief and skin temperature resulted in improved pain scores.It would be reasonable to suggest that ice packs be considered the standard of care for post delivery pain.A review of local cooling and pain relief found limited evidence for the use of cooling treatments in the perinatal period.It is reasonable to conclude that the efficacy of local cooling has tenable evidence at best, but none of the studies found harm or significant costs that hindered their use.

Most women experience pain after giving birth.The use of any agent to alleviate pain in the puerperium is preferred by patients and health care providers often order ice packs for their patients.Novel strategies are being developed to compete with traditional methods of pain control in the aftermath of a baby's birth.One new method involved injecting hyaluronidase to prevent trauma before it could cause pain.There is no evidence of superior benefit from any of these approaches.No one product has been shown to be more effective than another when it comes to pain control.

Epifoam: hydrocortisone + pramoxine hydrochloride.

The American College of Obstetricians and Gynecologists is located in Washington, DC.