***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND The full extent of genital tract trauma in spontaneous births is not well documented . The purpose of this study was to describe the range and extent of childbirth trauma and related postnatal pain using data from a large r and omized clinical trial of perineal management techniques ( n = 5471 ) . METHODS Descriptive analysis was conducted on trial participants who delivered spontaneously at term and were examined by their midwife after birth ( n = 5404 ) . Data are reported for sites of trauma , and the relation to episiotomy , suturing , and maternal reports of pain at 2 days , 10 days , and 3 months after birth . RESULTS Eighty-five percent of all women experienced some form of trauma , with first- or second-degree perineal lacerations occurring in two-thirds of women and outer vaginal tears occurring in one-half . Tears to the rectum and vaginal vault were more common with episiotomy . Nearly all unsutured trauma was restricted to perineal first- or second-degree , outer vaginal , and labial sites . Pain declined over time , and a gradient in pain was observed according to the site and complexity of trauma . CONCLUSIONS Genital tract trauma is extremely common with spontaneous vaginal birth . Effective measures to prevent or reduce its occurrence would benefit many new mothers Background Our aim was to describe the range of perineal trauma in women with a singleton vaginal birth and estimate the effect of maternal and obstetric characteristics on the incidence of perineal tears . Methods We conducted a prospect i ve observational study on all women with a planned singleton vaginal delivery between May and September 2006 in one obstetric unit , three freest and ing midwifery-led units and home setting s in South East Engl and . Data on maternal and obstetric characteristics were collected prospect ively and analysed using univariable and multivariable logistic regression . The outcome measures were incidence of perineal trauma , type of perineal trauma and whether it was sutured or not . Results The proportion of women with an intact perineum at delivery was 9.6 % ( 125/1,302 ) in nulliparae , and 31.2 % ( 453/1,452 ) in multiparae , with a higher incidence in the community ( freest and ing midwifery-led units and home setting s ) . Multivariable analysis showed multiparity ( OR 0.52 ; 95 % CI : 0.30–0.90 ) was associated with reduced odds of obstetric anal sphincter injuries ( OASIS ) , whilst forceps ( OR 4.43 ; 95 % CI : 2.02–9.71 ) , longer duration of second stage of labour ( OR 1.49 ; 95 % CI : 1.13–1.98 ) , and heavier birthweight ( OR 1.001 ; 95 % CI : 1.001–1.001 ) , were associated with increased odds . Adjusted ORs for spontaneous perineal truama were : multiparity ( OR 0.42 ; 95 % CI : 0.32–0.56 ) ; hospital delivery ( OR 1.48 ; 95 % CI : 1.01–2.17 ) ; forceps delivery ( OR 2.61 ; 95 % CI : 1.22–5.56 ) ; longer duration of second stage labour ( OR 1.45 ; 95 % CI : 1.28–1.63 ) ; and heavier birthweight ( OR 1.001 ; 95 % CI : 1.000–1.001 ) . Conclusions This large prospect i ve study found no evidence for an association between many factors related to midwifery practice such as use of a birthing pool , digital perineal stretching in the second stage , h and s off delivery technique , or maternal birth position with incidence of OASIS or spontaneous perineal trauma . We also found a low overall incidence of OASIS , and fewer second degree tears were sutured in the community than in the hospital setting s. This study confirms previous findings of overall high incidence of perineal trauma following vaginal delivery , and a strong association between forceps delivery and perineal trauma Objective To compare the effect of two methods of perineal management used during spontaneous vaginal delivery on the prevalence of perineal pain reported at 10 days after birth AIM AND OBJECTIVES Examining the ( experienced ) changes associated with a nursing intervention to enhance adherence to leg ulcer lifestyle advice . BACKGROUND Few interventions to enhance adherence to leg ulcer treatment are developed and tested . DESIGN Qualitative evaluation approach and pre-post-test design were used . METHOD Twenty-six patients with venous ulcers in a community care setting participated . Data were collected by means of interviews and participant observation . Frequency and duration of wearing compression , leg exercising and leg elevation , activity level , pain and ulcer size were registered at baseline , after the end of the intervention and three months later . Inductive content analysis and Wilcoxon signed-rank test were used . RESULTS Knowledge about leg ulcer advice increased . The education contributed to more consciously following of the advice . The rationale of the advice and its association with healing or recurrence remained often unclear . More patients performed exercises after the intervention and at follow-up . Patients often looked out onto a ' new ' perspective where enhancement of quality of life and even healing might be attainable . Some patients regained independence after learning how to apply and remove compression garments themselves . The frequency of exercising and the duration of exercises increased significantly . Step counts had not altered significantly . Patients not elevating the legs at baseline elevated the legs more and for a longer period of time after the intervention . This effect on leg elevation decreased after three months . No significant changes were reported on hours wearing compression . CONCLUSIONS The perceived changes suggest that the intervention holds a promise for current home care . Combining qualitative and quantitative research assisted to determine the possible effects of the intervention , increasing the potential for a meaningful r and omised trial in the future . RELEVANCE TO CLINICAL PRACTICE Education about leg ulcer advice should be incorporated in nursing practice . Further testing of the intervention is recommended Genital tract trauma after spontaneous vaginal childbirth is common , and evidence -based prevention measures have not been identified beyond minimizing the use of episiotomy . This study r and omized 1211 healthy women in midwifery care at the University of New Mexico teaching hospital to 1 of 3 care measures late in the second stage of labor : 1 ) warm compresses to the perineal area , 2 ) massage with lubricant , or 3 ) no touching of the perineum until crowning of the infant 's head . The purpose was to assess whether any of these measures was associated with lower levels of obstetric trauma . After each birth , the clinical midwife recorded demographic , clinical care , and outcome data , including the location and extent of any genital tract trauma . The frequency distribution of genital tract trauma was equal in all three groups . Individual women and their clinicians should decide whether to use these techniques on the basis of maternal comfort and other considerations 
    Output:
    
Appropriate patient education positively impacts on wound-healing rates and compliance with wound care .
We set out to evaluate the RCT evidence pertaining to the impact of antenatal education on perineal wound healing in postnatal women who have birthed in a hospital setting , and who experienced a break in the skin of the perineum as a result of a tear or episiotomy , or both .
There is a lack of evidence concerning whether or not antenatal education relating to perineal wound healing in this cohort of women will change the outcome for these women in relation to wound healing , infection rate , re-attendance or re-admission to hospital , pain , health-related quality of life , maternal bonding , and negative emotional experiences .