Elsevier

Journal of Minimally Invasive Gynecology

Volume 13, Issue 5, September–October 2006, Pages 457-462
Journal of Minimally Invasive Gynecology

Original article
A randomized comparison of suturing techniques for episiotomy and laceration repair after spontaneous vaginal birth

https://doi.org/10.1016/j.jmig.2006.06.006Get rights and content

Abstract

Study objective

To compare the continuous knotless technique of perineal repair with the interrupted method after spontaneous vaginal birth

Design classification

Canadian Task Force Classification I.

Setting

This study was undertaken in a university hospital with more than 2200 deliveries per year. The static population of this district includes a wide range of socioeconomic classes and is predominately white.

Patients

From May 1 to November 19, 2003, 214 primiparous women with a second-degree perineal tear or episiotomy were randomly allocated to either the continuous knotless technique (CKT; n = 107) or the interrupted technique (IT; n = 107) suturing method.

Interventions

The interrupted technique (IT) involves placing 3 layers of sutures whereas the continuous knotless technique (CKT) involves reapproximating vaginal trauma, perineal muscles, and skin with a loose, continuous, nonlocking technique.

Measurements and main results

The primary outcomes of the study were perineal pain (evaluated by visual analogue scale) at 48 hours and day 10 and dyspareunia 3 months after delivery. Secondary outcomes included suture removal, wound dehiscence, analgesia use up to 48 hours, and satisfaction with repair established at 3 and 12 months after childbirth. At day 10, 19 women had dropped out of the study. Significantly fewer women reported pain at 10 days with the CKT than with the IT (32.3% vs 60.4%; p < .001). Analgesia use up to 48 hours postpartum was less in the CKT group than in the IT group (33.6% vs 54.2%; p < .05). No difference was found in superficial dyspareunia at 3 months for the CKT versus the IT group.

Conclusion

The use of a continuous knotless technique for perineal repair is associated with less short-term pain than techniques with interrupted sutures.

Section snippets

Materials and methods

This study was undertaken in a university hospital with more than 2200 deliveries per year. The static population of this district includes a wide range of socioeconomic classes and is predominately white. The local research ethics committee approved the study.

Results

From May 1 to November 19, 2003, 1135 women delivered in our department. Of them 379 women underwent caesarean sections, and 756 had vaginal delivery. Of the 756 women with vaginal delivery, only 214 (107 in the CKT group and 107 in the IT group) met the inclusion criteria and had signed the informed consent, as is shown in Figure 1.

The 2 groups were comparable at entry in important respects (Table 1). Results are shown in Table 2.

At day 10, 19 women had dropped out of the study (8 in the CKT

Discussion

Millions of women throughout the world experience pain and suffering as a result of perineal trauma sustained during delivery,18 and yet this is a very underresearched area. In Italy the perineal suture is considered a “surgical” act and, until the time this study was carried out, in our department only medical doctors could perform perineal suturing.

For nearly 70 years, researchers have been suggesting that continuous repair techniques are better than interrupted suture methods in terms of

Conclusion

The use of a continuous knotless technique for perineal repair is associated with less short-term pain than techniques with interrupted sutures. Indeed, the introduction of a continuous suturing policy would reduce overall expenditure, because less suturing material is needed than for the interrupted method of repair.

Acknowledgments

We thank the women who participated in the study and the many midwives and doctors, particularly Bruno Brusacà, Tiziana Fortunato, and Alessandra Parodi, without whose help the trial would not have been possible.

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      It identified 16 randomized controlled trials involving 8184 women from 8 countries, comparing “continuous suture methods” to “traditional discontinuous suture methods”. It was found that continuous suture techniques, compared to discontinuous methods, are associated with less pain at 10 days postpartum, as well as less need for analgesia and shorter suture removal time [8–11]. Moreover, continuous suture techniques are more cost effective than discontinuous suture methods (one thread versus two or three, respectively) [8,12].

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      For this reason, the use of episiotomy should be restricted when attending low risk births (Previatti and de Souza, 2007; Jiang et al., 2017). In addition, the use of continuous sutures is recommended for perineal repair after childbirth given that this type of suture is associated with a lower incidence of short-term perineal discomfort (Morano et al., 2006; Almeida and Riesco, 2008; Kettle et al., 2012). However, the continuous suture technique, as endorsed by scientific evidence, has not been implemented for perineal trauma repair in our clinical practice environment.

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