A randomized comparison of suturing techniques for episiotomy and laceration repair after spontaneous vaginal birth.
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.
Morano
Sandra
S
Department of Obstetrics and Gynaecology, San Martino Hospital and University of Genova, Genova, Italy.
Mistrangelo
Emanuela
E
Pastorino
Daniela
D
Lijoi
Davide
D
Costantini
Sergio
S
Ragni
Nicola
N
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*