Comparative analysis of continuous and interrupted suturing techniques for repair of episiotomy or second degree perineal tear

Authors

  • Sunil Kumar Samal Department of Obstetrics and Gynecology, Mahatma Gandhi Medical College & Research Institute, Pillaiyarkuppam, Pondicherry, India
  • Setu Rathod Department of Obstetrics and Gynecology, Mahatma Gandhi Medical College & Research Institute, Pillaiyarkuppam, Pondicherry, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20170573

Keywords:

Episiotomy, Second degree perineal tear, Visual analogue scale score

Abstract

Background: Perineal trauma is a serious and frequent problem after childbirth which is experienced by millions of women worldwide and the type of perineal repair may have an impact on pain and healing. The objective of this study was to assess the effects of continuous subcuticular versus interrupted transcutaneous sutures on women following episiotomy or second degree perineal repair following childbirth.

Methods: A prospective comparative study comprising 141 women who had undergone vaginal deliveries with episiotomies or second-degree tearing of the perineum between August 2015 and July 2016Two groups were made among which one group was repaired with continuous, nonlocking sutures involving the vagina, perineum, and subcutaneous tissues and the other group had continuous, locking sutures of the vagina, interrupted sutures in the perineal muscles, and interrupted transcutaneous sutures. The threads used for stitching were identical in both groups i.e. rapidly absorbed polyglactin 910 suture material.

Results: On the 2nd day after delivery, the perineal pain scores during lying, sitting and walking in the continuous technique(CT) group was less compared to the interrupted technique(IT) group(p value 0.009). On 10th day after delivery the perineal pain score during sitting and walking were statistically less (p value 0.027) in the CT group.  On 42th day there was no difference in pain score between both the groups. The amount of suture materials consumed in CT group was statistically less than IT group(p<0.001). There was no difference in incidence of wound dehiscence (p value 0.301) but superficial dyspareunia is more in IT group which is statistically significant.

Conclusions: The episiotomy and perineal tear repairs with continuous suturing associated with lesser incidence of short or long term pain, lesser requirement of suture material without an increase in complication than interrupted suturing.

References

Penna LK. Episiotomy. In: Arulkumaran S, Penna LK, Rao BK, eds. the Management of Labour. 2nd ed. Chennai: Orient Longman Publishers;2005:157.

Sleep J, Grant A, Gracia J, Elbourne D, Spencer J, Chalmers I. West Berkshire perineal management trail. Br Med J (Clin Res Ed). 1984;289(6445):587-90.

Weber AM, Meyn L. Episiotomy use in the United States, 1979-1997. Obstet Gynaecol. 2002;100(6):1177-82.

Ogunyemi D, Maniget B, Marquis J, Bazargan M. Demographic variation and clinical association of episiotomy and severe perineal laceration in vaginal delivery. J Nat Med Asso. 2006;98:1874-81.

Kettle C, Hills RK, Ismail KMK. Continuous versus interrupted sutures for repair of episiotomy or second degree tears. Cochrane Database of Systematic Reviews. John Wiley & Sons;2007:4.

Almeida SF, Riesco ML. Randomized controlled clinical trial on two perineal trauma suture techniques in normal delivery. Rev Lat Am Enfermagem. 2008;16(2):272-9.

Kokanalı D, Ugur M, Kuntay Kokanalı M, Karayalcın R, Tonguc E. Continuous versus interrupted episiotomy repair with monofilament or multifilament absorbed suture materials: a randomised controlled trial. Arch Gynecol Obstet. 2011;284(2):275-80.

Kettle C, Dowswell T, Ismail KM. Continuous and interrupted suturing techniques for repair of episiotomy or second-degree tears. Cochrane Database Syst Rev. John Wiley & Sons; 2012:14.

Kettle C, Hills RK, Jones P, Darby L, Gray R, Johanson R. Continuous versus interrupted perineal repair with standard or rapidly absorbed sutures after spontaneous vaginal birth: a randomised controlled trial. Lancet. 2002;359(9325):2217-23.

Morano S, Mistrangelo E, Pastorino D, Lijoi D, Costantini S, Ragni N. A randomized comparison of suturing techniques for episiotomy and laceration repair after spontaneous vaginal birth. J Minim Invasive Gynecol. 2006;13(5):457-62.

Bick DE, Kettle C, MacDonald S, Thomas PW, Hills RK, Ismail KMK. BMC Pregnancy and Childbirth. 2010;10:10.

Mahomed K, Grant A, Ashurst H, James D. The Southmead perineal suture study. A randomized comparison of suture materials and suturing techniques for repair of perineal trauma. Br J Obstet Gynaecol. 1989;96:1272-80.

Banninger U, Buhrig H, Schreiner WE. A comparison between chromic catgut and polyglycolic acid sutures in episiotomy repair. Geburtshilfe Frauenheilkd. 1978;38:30-3.

Kettle C, Dowswell T, Ismail KM. Absorbable suture materials for primary repair of episiotomy and second degree tears. Cochrane Database Syst Rev. John Wiley & Sons;2010:6.

Detlefsen GU, Vinther S, Larsen P, Schroeder E. Intradermal suturing of episiotomy wounds compared with interrupted sutures. Ugeskrift for Laeger. 1980;142:3117-20.

Valenzuela P, Saiz Puente MS, Valero JL, Azorín R, Ortega R, Guijarro R. Continuous versus interrupted sutures for repair of episiotomy or second-degree perineal tears: a randomised controlled trial. BJOG. 2009;116(3):436-41.

Downloads

Published

2017-02-19

Issue

Section

Original Research Articles