title: A randomised trial, conducted by midwives, of perineal repairs comparing a polyglycolic suture material and chromic catgut.
abstract: OBJECTIVE
  to assess the effect of suture materials (an absorbable synthetic suture material versus catgut) used in perineal repairs undertaken by midwives who had been trained and accredited in repair techniques.
  
  
  METHODS
  randomised controlled trial.
  
  
  METHODS
  tertiary obstetric hospital in Australia.
  
  
  METHODS
  391 women with a live singleton birth at > or =34 weeks gestation, resulting from a spontaneous vaginal delivery and who required perineal repair due to either an episiotomy or first or second degree tear.
  
  
  METHODS
  eligible women were randomly allocated for repair with either polyglycolic acid or chromic catgut.
  
  
  METHODS
  perineal pain and dyspareunia up to six months postpartum.
  
  
  RESULTS
  of the 194 women allocated to polyglycolic suture 106 (55%) were primipara compared with 79 (40%) of the 197 women allocated to catgut. Due to this unexplained imbalance, odds ratios were estimated with and without adjustment for parity. The parity-adjusted odds ratios were little changed (<11%) from the crude odds ratios. Although there were no statistically significant differences, parity-adjusted odds ratios (aOR) suggest that compared with women sutured with catgut, women sutured with polyglycolic were less likely to experience perineal pain at Day 3 postpartum (aOR=0.70 95% confidence interval [95% CI] 0.46-1.08) but by six months postpartum were somewhat more likely to experience perineal pain (aOR=1.77, 95% CI 0.57-5.47), dyspareunia (aOR=1.21 [0.62-2.33] and require removal of a suture (aOR=2.61 95% CI 0.59-12.41).
  
  
  CONCLUSIONS
  the finding of reduced short-term perineal pain in women repaired with polyglycolic compared with catgut is similar to that of a Cochrane Systematic Review. The possibility that polyglycolic is associated with worse longer-term outcomes has not been previously reported but is biologically plausible (catgut causes a local inflammatory reaction but is rapidly absorbed, while polyglycolic causes little inflammation but absorption takes longer). This trial also illustrates the difficulties of undertaking clinical research in a busy delivery ward.
authors.affiliation: Nurse Unit Manager, Deliver Ward, King George V Hospital, Sydney, Australia.
authors.forename: Alexis
authors.initials: A
authors.lastname: Upton
authors.forename: Christine L
authors.initials: CL
authors.lastname: Roberts
authors.forename: Maureen
authors.initials: M
authors.lastname: Ryan
authors.forename: Margaret
authors.initials: M
authors.lastname: Faulkner
authors.forename: Maree
authors.initials: M
authors.lastname: Reynolds
authors.forename: Camille
authors.initials: C
authors.lastname: Raynes-Greenow
mesh_terms: D000328:Adult; D001315:Australia; D002398:Catgut / Q000009:adverse effects; D002857:Chromium; D005260:Female; D006801:Humans; D008880:Midwifery / Q000592:standards; D007744:Obstetric Labor Complications / Q000601:surgery*; D016017:Odds Ratio; D010146:Pain / Q000209:etiology; D010502:Perineum / Q000293:injuries / Q000601:surgery*; D011100:Polyglycolic Acid / Q000009:adverse effects; D011247:Pregnancy; D013536:Suture Techniques; D013537:Sutures / Q000009:adverse effects; D013997:Time Factors; D014945:Wound Healing
chemical_list: D002857:Chromium; D011100:Polyglycolic Acid