The Ipswich childbirth study: one year follow up of alternative methods used in perineal repair.
OBJECTIVE
To assess the long term implications of four alternative approaches to postpartum perineal repair.


METHODS
A stratified randomised controlled trial using a 2x2 factorial design.


METHODS
Original recruitment at the Maternity Unit at Ipswich Hospital NHS Trust, a district general hospital, between 1992 and 1994.


METHODS
Seven hundred and ninety three women who had participated in the Ipswich Childbirth Study--a trial among women who had required repair of episiotomy or first or second degree tears--at least one year previously.


METHODS
Self-completed postal follow up at least one year after recruitment to trial comparing 1. two-stage repair leaving the skin unsutured with standard three-stage repair, and 2. polyglactin 910 with chromic catgut as suture material for the repair.


METHODS
Failure to resume pain-free intercourse; persistent perineal pain; perineum feeling different; resuturing; time to resume pain-free intercourse; and dyspareunia.


RESULTS
Fewer women allocated two-stage repair reported that the perineum felt different (30% versus 40%; RR 0.75; 95% CI 0.61 to 0.91; 2P < 0.01); otherwise there were no clear differences between the two methods. Women allocated polyglactin 910 were less likely to have dyspareunia (8% versus 13%; RR 0.59, 95% CI 0.39 to 0.91; 2P = 0.02) and less likely to fail to resume pain-free intercourse (8% versus 14%; RR 0.57, 95% CI 0.38 to 0.87; 2P < 0.01).


CONCLUSIONS
Two-stage repair of perineal trauma leaving the skin unsutured appears to reduce the likelihood of the perineum feeling different from before delivery, in addition to less pain and dyspareunia initially; there were no apparent disadvantages. Polyglactin 910 reduces dyspareunia long term, indicating that the short term benefits of this material over chromic catgut persist.
Grant
A
A
Health Services Research Unit, Aberdeen, UK.
Gordon
B
B
Mackrodat
C
C
Fern
E
E
Truesdale
A
A
Ayers
S
S
D000328:Adult; D002398:Catgut / Q000009:adverse effects; D004414:Dyspareunia / Q000209:etiology; D004841:Episiotomy / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007744:Obstetric Labor Complications / Q000601:surgery*; D010502:Perineum / Q000293:injuries* / Q000601:surgery; D011098:Polyglactin 910 / Q000009:adverse effects; D011247:Pregnancy; D013536:Suture Techniques / Q000009:adverse effects*; D016896:Treatment Outcome
D011098:Polyglactin 910