***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 
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    Input: The objective of the present study was to compare three methods of  cryotherapy  in healthy non-pregnant women . This is a r and omized controlled clinical trial that was conducted by 32 undergraduates of a private nursing college in the city of Sao Paulo , divided into three groups ( iced water , soft ice , ice gel ) . The temperatures were verified ( axillary , thigh , of the three ice packs ) between zero and twenty minutes . The temperatures of the packs were the following : soft ice , from negative 9 degrees C to 2 degrees C ; iced water , from 0 degrees C to 8 degrees C ; and ice gel from negative 11 degrees C to 2 degrees C. There was a significant difference between the average thigh temperature values at 10 minutes ( p = 0.007 ) , 15 minutes ( p = 0.003 ) and 20 minutes ( p = 0.005 ) . The gel was the most efficient cooling method . The three cryotherapy methods achieved the recommended temperature for analgesia and may be tested in women with perineal pain after childbirth Systematic review s of r and omized controlled trials have demonstrated that episiotomies should not be performed routinely and that performing episiotomies in no more than 10 % of nulliparas being delivered vaginally would be safe .  Episiotomy  rates are reported for nulliparous and multiparous women in hospitals in Argentina Brazil Bolivia Chile the Democratic Republic of Congo Ecuador India Tibet Uruguay Venezuela and Zambia . These hospitals are part of the National Institute of Child Health and Human Development ’s Global Network for Women ’s and Children ’s Health Research . Data were collected using a survey form completed by investigators at 7 sites between April and December 2003 . All sites collected hospital-based data extracted from routine labor and delivery logbooks or from labor and delivery records . A site refers to an investigative team reporting data from 1 or more countries participating in the Global Network . Episiotomy rates are reported both by site and by mean rates and ranges across sites . ( excerpt The effect of cold sitz baths for relieving  perineal pain in the postpartum period after an episiotomy was evaluated . Forty patients took both cold and warm sitz baths  with r and om assignment of the initial bath . Patients rated the degree of perineal pain before and after each sitz bath and at half-hour and one-hour intervals after each bath . A pain scale using 0 - 5 , 0 representing no pain and 5 representing extreme pain , was used . Analysis of pain scale scores using a two-way analysis of variance with replications showed that cold sitz baths were significantly more effective in relieving perineal pain . The greatest amount of pain relief was experienced immediately after the cold sitz baths 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 OBJECTIVE To evaluate the effectiveness of st and ard regimes ( ice packs and Epifoam ) at relieving perineal trauma and compare these with a new cooling device ( maternity gel pad ) . DESIGN A r and omised controlled trial involving three treatment groups . The women were free to choose the time of initial application ( within four hours after delivery ) in all treatment groups and the number of subsequent treatments up to 48 hours after suturing . SETTING A midwifery unit in the north of Engl and and then continued in the women 's own homes . PARTICIPANTS 120 women who had undergone an instrumental delivery and had a 48 hours post-delivery stay in a postnatal ward . MEASUREMENTS AND FINDINGS The ordinal scale of none , mild , moderate and severe was used to determine the levels of perineal oedema and bruising at initial assessment ( less than 4 hours ) , 24 hours and at 48 hours , by use of a newly developed visual evaluating tool . Self-assessed pain was recorded using a 10-point visual analogue scale within four hours , at 24 hours , 48 hours , and finally at five days after suturing . Women 's opinions as to the effectiveness of their treatment was rated by use of a 5-point scale describing the categories ; poor , fair , good , very good and excellent . A high proportion of women had some perineal oedema at initial assessment . A statistically significant difference in the proportion of women with oedema was found between treatment groups at 48 hours ( p = 0.01 ) , which was in favour of the maternity gel pad group . This was particularly noticeable for women with initial levels of mild oedema ( p = 0.017 ) . Localised treatment with the gel pad caused a significant decrease in reported pain at 48 hours in women who initially demonstrated moderate or severe pain ( p = 0.048 ) . A significant increase in the proportion of women with some bruising was seen across all treatment groups from initial assessment , through 24 hours to 48 hours ( p < 0.0005 ) . The bruising was significantly less in the gel-pad group in women who initially had no bruising ( p = 0.021 ) . There was no statistically significant effect of treatment at other initial levels of severity for oedema , bruising or pain at 24 hours , 48 hours and five days ( for pain ) . Women in the gel-pad group rated the effectiveness of their localised treatment to be significantly higher than women in the other two treatment groups ( p < 0.0005 ) . KEY CONCLUSIONS This trial demonstrated that a high proportion of women experience perineal oedema , bruising and pain following an instrumental delivery , which continues for at least five days for perineal pain , despite oral analgesia . Maternity gel pads , which were specially design ed to cool the perineal region , were more effective in alleviating perineal trauma when compared with hospital st and ard regimens and were more highly rated by women The association between  episiotomy and severe ( third- and fourth-degree ) perineal lacerations was studied in 24,114 women . The overall rates of severe lacerations were 8.3 and 1.5 % for primiparous and multiparous women , respectively . Women who had  midline episiotomies  were nearly 50 times more likely and women who had mediolateral episiotomies were over eight times more likely to suffer a severe laceration than were women who did not undergo an episiotomy .  Severe lacerations were also more common after use of forceps , in occiput transverse and posterior presentations , among women with smaller pelvic outlet measurements or lower prepregnant weight , and with larger fetuses . The same factors that caused a woman to have an increased risk of laceration also made performance of an episiotomy more likely . After statistical adjustment for these risk factors , mediolateral episiotomy was associated with a 2.5-fold reduction in the risk of severe lacerations among primiparous women , and a statistically nonsignificant 2.4-fold increase among multiparous women , compared with no episiotomy . Midline episiotomy was associated with statistically significant 4.2- and 12.8-fold increases in the risk of lacerations among primiparous and multiparous women , respectively . We conclude that the risks and benefits of midline episiotomy should be evaluated in a r and omized clinical trial that compares policies of “ usual ” versus conservative use of episiotomy Ultrasound and pulsed electromagnetic energy therapies arc increasingly used for perineal trauma sustained during childbirth . The study included 414 women with moderate or severe perineal trauma r and omly allocated to receive active ultrasound , or active pulsed electromagnetic energy , or corresponding placebo therapies ; the allocation was double‐blind for each machine . Overall , more than 90 % thought that treatment made their problem better . There were no clear differences between the groups in outcome either immediately after treatment , or 10 days or 3 months postpartum , other than more pain associated with pulsed electromagnetic energy treatment at 10 days . Bruising looked more extensive after ultrasound therapy but then seemed to resolve more quickly . Neither therapy had an effect on perineal oedema or haemorrhoids . The place of these new therapies in postnatal care should be clarified by further controlled trials before they become part of routine care Perineal discomfort from episiotomy continues to be a problem for many postpartum women . The purpose s of this study were to compare the effect of ice bag and heat lamp for the relief of perineal discomfort and to identify the sustaining time of each effect . Forty women took ice bag and heat lamp  with r and om assignment of initial therapy . Women rated the degree of perineal discomfort before and after each therapy and at half-hour , tow-hour and four-hour intervals after each therapy . A discomfort scale , 18 cm graphic rating scale , was used . The results of the study were as follows : 1 . The ice bag group showed significantly lower discomfort score than the heat lamp group at the half-hour and two-hour intervals after therapy . 2 . The ice bag group showed significantly lower discomfort score for 4hrs after than before therapy , but the heat lamp group did not show significantly lower discomfort score . 3 . Neither the type of episiotomy nor the previous experience of heat therapy influenced on the effect of ice bag relieving the perineal discomfort . Therefore ice bag was significantly more effective in relieving perineal discomfort than heat lamp . Subjective responses of patients who took both therapy were very favorable toward ice bag . I suggested that nurses should provide women with adequate information about the use of ice bag and encourage to apply ice bag instead of heat lamp after episiotomy in order to promote the relief of perineal discomfort and the healing of perineal wound 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 BACKGROUND Perineal pain is one of the most common causes of maternal morbidity in the early puerperium . Several r and omized trials have shown that topical application of local anesthetics is effective in reducing postepisiotomy pain , but no r and omized study has assessed the efficacy of local anesthetics for other perineal trauma . This study investigated if topically applied 2 percent lignocaine gel was an effective treatment for this group of women . METHODS A double-blind placebo controlled trial was conducted in a regional teaching hospital in the northwest of Engl and . One hundred and forty-nine women who had sustained a first- or second-degree tear were allocated by sealed envelopes to the lignocaine gel or placebo group . The primary outcome was self-reported pain at 24 hours postdelivery as measured on a numerical rating scale ( pain score ) . Secondary outcomes included pain scores at 48 hours , the need for oral analgesia , and maternal satisfaction . Based on a pilot study , we calculated that 128 women were required to detect a 25 percent difference in pain scores between the two groups with 80 percent power ( alpha = 0.05 ) . The pain scores of women in each trial arm were compared using the unpaired t test and 95 percent confidence intervals . RESULTS Women using lignocaine gel had lower average pain scores , although this only reached statistical significance at 48 hours after delivery ( p = 0.023 ) . In general , women liked using the study gel . No difference was found in consumption of oral analgesia . CONCLUSIONS This study suggested that lignocaine gel may be effective on the second postnatal day . Further research is required to assess the optimum timing of this intervention and the population that would most benefit from its use Abstract Midwives ' management of  postpartum perineal pain  was surveyed in 50 r and omly selected English maternity units . First line management was usually oral analgesia ( 78 % ) although some units first offered local ice , hydrocortisone and pramoxine foam ( Epifoam ) , or witch hazel . Paracetamol was the oral analgesic of choice for mild perineal pain but there was wide variation in the choice of oral analgesia for more severe pain ; the most common practice was to use paracetamol in combination with a stronger analgesic . Ice was the most popular local treatment ( 84 % of units ) but hydrocortisone/pramoxine foam ( Epifoam ) and therapeutic ultrasound were also popular . Many of the therapies mentioned in the survey remain poorly evaluated . Further controlled trials are needed to clarify their place in postnatal care Thirty healthy patients undergoing lumbar spine surgery were r and omly assigned to one of two groups for postoperative pain relief . Group 1 received morphine via patient controlled analgesia and local cooling of the wound by an externally applied cooling pad while group 2 received patient controlled analgesia alone . There was a significant reduction in morphine consumption when local cooling was applied ( 18.6 mg versus 30.2 mg at 12h , 29.0 mg versus 49.6 mg at 24 h , p < 0.05 ) . Patients were also significantly more satisfied with their overall postoperative pain management when cooling therapy was used INTRODUCTION This study evaluated the effectiveness of an ice pack applied for 2 
    Output:
    
AUTHORS ' CONCLUSIONS There is only limited evidence to support the effectiveness of local cooling treatments ( ice packs , cold gel pads , cold/iced baths ) applied to the perineum following childbirth to relieve pain