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