title: A randomized comparison of suturing techniques for episiotomy and laceration repair after spontaneous vaginal birth.
abstract: OBJECTIVE
  To compare the continuous knotless technique of perineal repair with the interrupted method after spontaneous vaginal birth
  
  
  METHODS
  A randomized controlled trial.
  
  
  METHODS
  Canadian Task Force Classification I.
  
  
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  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.
  
  
  CONCLUSIONS
  The use of a continuous knotless technique for perineal repair is associated with less short-term pain than techniques with interrupted sutures.
authors.affiliation: Department of Obstetrics and Gynaecology, San Martino Hospital and University of Genova, Genova, Italy.
authors.forename: Sandra
authors.initials: S
authors.lastname: Morano
authors.forename: Emanuela
authors.initials: E
authors.lastname: Mistrangelo
authors.forename: Daniela
authors.initials: D
authors.lastname: Pastorino
authors.forename: Davide
authors.initials: D
authors.lastname: Lijoi
authors.forename: Sergio
authors.initials: S
authors.lastname: Costantini
authors.forename: Nicola
authors.initials: N
authors.lastname: Ragni
mesh_terms: D000328:Adult; D004841:Episiotomy; D005260:Female; D006801:Humans; D022125:Lacerations / Q000209:etiology / Q000601:surgery*; D007744:Obstetric Labor Complications / Q000601:surgery*; D010146:Pain / Q000517:prevention & control; D010502:Perineum / Q000293:injuries* / Q000601:surgery*; D011247:Pregnancy; D011644:Puerperal Disorders / Q000517:prevention & control; D013536:Suture Techniques; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery*