Episiotomy Assessment

Episiotomy Assessment

The REEDA Scale (Redness, Edema, Ecchymosis, Discharge, Approximation) is a scale for grading the severity of perineal trauma associated with episiotomy or laceration associated with delivery.

Procedure:

  1. The patient is in the lateral Sims position.
  2. A 4 cm wide piece of paper tape is placed so that its midline runs along the length of the wound.

Parameters:

  1. redness
  2. edema
  3. ecchymosis
  4. discharge
  5. approximation
Parameter Finding Points
redness none 0
within 0.25 cm of the incision bilaterally 1
within 0.50 cm of the incision bilaterally 2
beyond 0.50 cm of the incision bilaterally 3
edema none 0
perineal, < 1 cm from the incision 1
perineal and/or vulvar, 1-2 cm from the incision 2
perineal and/or vulvar, > 2 cm from the incision 3
ecchymosis none 0
within 0.25 cm bilaterally or 0.5 cm unilaterally 1
within 1.0 cm bilaterally or 0.5-2.0 cm unilaterally 2
> 1 cm bilaterally or > 2 cm unilaterally 3
discharge none 0
serum 1
serosanguinous 2
bloody, purulent 3
approximation closed 0
skin separation <= 3 mm 1
skin and subcutaneous fat separated 2
skin, subcutaneous fat and fascial layer separation 3

REEDA score =

= SUM(points for all 5 parameters)

Interpretation:

  • minimum score: 0
  • maximum score: 15
  • The higher the score the more severe the perineal trauma.

Limitations:

  • Measurement is somewhat intrusive and is somewhat difficult to perform in a non-hospital setting without an assistant.
  • The tape can be difficult to read if it becomes soiled.
References:
  • Davidson NS. REEDA: evaluating postpartum healing. J Nurs & Midwif. 1974; 19: 68
  • Hill P. Effect of hot and cold on the perineum after episiotomy/laceration. J Obstet & Gynecol Neonatal Nurs. 1989; 18: 124-129.
  • Steen M, Cooper K. A tool for assessing perineal trauma. J Wound Care. 1997; 6: 432-436.