Postpartum GRANulation Tissue: The GRANT Study

Project Abstract: Women who sustain obstetric lacerations are often treated with local vaginal estrogen by their obstetricians to facilitate healing. Systemic estrogen levels are low in the postpartum period, especially in breastfeeding women, and many clinicians assume that local estrogen may improve outcomes after obstetric lacerations. The majority of women who sustain a severe obstetric laceration at Prentice follow up at our multidisciplinary PEAPOD (Peripartum Evaluation and Assessment of the Pelvic Floor Around the time of Delivery) clinic. In PEAPOD, we have observed that women treated with vaginal estrogen have a higher frequency of developing vaginal and perineal granulation tissue compared to those who are not treated with vaginal estrogen. This granulation tissue manifests as an exquisitely painful, fibrotic, and inflammatory area of scarring at the site of the healing laceration. While the formation of some granulation tissue is a normal component of the wound-healing cascade, this tissue may become pathologically excessive and persist in the vagina and perineum. Due to pain and bleeding, this abnormal tissue often necessitates treatment in the office and/or operating room. We aim to elucidate the biomolecular properties of this granulation tissue in order to improve postpartum recovery for women delivering at Prentice and around the world.