Physical Rehabilitation for Postpartum Perineal Morbidity After Episiotomy and Childbirth-Related Perineal Trauma: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Abstract

Background: Postpartum perineal trauma commonly causes pain and delayed maternal recovery, yet randomized evidence supporting rehabilitation interventions remains fragmented.

Objective: To compare the effectiveness of physical and electrophysical rehabilitation modalities for postpartum perineal pain, wound healing, and oedema following episiotomy or childbirth-related perineal trauma.

Methods: This systematic review and meta-analysis was conducted in accordance with PRISMA 2020. PubMed/MEDLINE, Embase, CENTRAL, CINAHL, ClinicalTrials.gov, and ICTRP were searched from inception to April 7, 2026. Randomized controlled trials evaluating rehabilitation modalities were included. Random-effects meta-analysis was performed where appropriate, and methodological quality was assessed using the Cochrane Risk of Bias 2 tool.

Results: Nine randomized controlled trials were included, seven of which contributed to quantitative synthesis. TENS significantly reduced short-term postpartum perineal pain compared with control (SMD -1.19, 95% CI -1.83 to -0.55). LLLT showed no significant benefit (SMD -0.16, 95% CI -0.52 to 0.19), while therapeutic ultrasound demonstrated no significant reduction in persistent pain. Narrative evidence indicated favorable effects of cooling interventions on oedema, immediate pain relief, and maternal satisfaction. Two studies were judged at low risk of bias, five had some concerns, and two were at high risk of bias.

Conclusions: This review provides the first comparative synthesis of randomized evidence evaluating physical and electrophysical rehabilitation modalities for postpartum perineal morbidity. The strongest evidence currently supports TENS for short-term pain relief, whereas cooling interventions appear beneficial for local symptom management. Larger, rigorously designed randomized trials are required to establish evidence-based rehabilitation strategies for postpartum perineal recovery.