Continuous versus discontinuous suture in perineal injuries produced during delivery in primiparous women: a randomized controlled trial

Abstract

BackgroundThe technique used in the repair of a perineal injury resulting from childbirth could avoid discomfort and morbidity during the postpartum period. Recent studies show inconsistent results and support the need for new research with the inclusion of new health parameters not yet studied. Therefore, this study aims to evaluate if the suture technique (continuous or interrupted) has an effect on pain and other postpartum problems, incidence of incontinence (urinary and/or fecal), and the restart of sexual relations.MethodsA single-blind randomized clinical trial was conducted in five hospitals in south-east Spain. The participants were primiparous women who had experienced a perineal injury during delivery (second-degree tear or episiotomy). Data was collected on sociodemographic variables, variables associated with pregnancy, labor and delivery, and the postpartum period, and outcomes during the 3 months after delivery: pain, incontinence, and restart of sexual relations. Odds ratios (OR) were calculated by binary logistic regression to assess the influence of the suture type on binary outcomes and t-test used for comparing continuous outcomes. Multivariate analyses (using logistic regression -adjusted (aOR)- and analysis of covariance) were carried out to adjust for unbalanced variables after randomization.ResultsA total of 70 women were included in the intervention group (continuous suture) and 64 in the reference group (interrupted sutures). A negative association was observed (aOR = 0.39; 95% CI = 0.18–0.86) between a continuous suture and the need for analgesia at 24 h postpartum. Pain experienced by the women at 24 h postpartum was assessed as 4.4 ± 0.3 compared with a score of 3.4 ± 0.3 in the group with continuous sutures (p = 0.011). At 15 days postpartum, women in the intervention group experienced less pain (aOR = 0.38; 95% CI = 0.18–0.80) (p = 0.019). Urinary sphincter incontinence was also evaluated at 15 days, with 4.3% (n = 3) of the women in the intervention group presenting with urinary incontinence compared with 18.8% (n = 12) in the control group (aOR = 0.11; 95% CI = 0.03–0.47) (P = 0.003).ConclusionsThe women who had a continuous suture repair showed lower levels of pain from delivery to 3 months after delivery and had a lower incidence of urinary incontinence at 15 days postpartum.Trial registrationClinicalTrials.gov NCT03825211 posted January 31, 2019 (retrospectively registered).

Perineal Injury and Its Association with Postpartum Sexual Dysfunction among First Delivery Women

“…An earlier study by Hasanpoor et al [20] showed that pain severity was similar if repaired by either method. A recent study however showed that women who had a continuous suture repair had lower levels of pain [21]. These factors can be suggested to be taken into consideration in future studies.…”

Digestive tract reconstruction in pancreaticoduodenectomy in University Hospitals of China: a national questionnaire survey

“…Furthermore, even in single-layer PJ, there are continuous and interrupted techniques, and no clinical controlled studies have been reported for these two suturing methods, while similar RCTs have been reported for the small intestine, mitral valve, and obstetric tract surgery. [18–20]…”

“…Furthermore, even in single-layer PJ, there are continuous and interrupted techniques, and no clinical controlled studies have been reported for these two suturing methods, while similar RCTs have been reported for the small intestine, mitral valve, and obstetric tract surgery. [18][19][20] This survey was also noteworthy with variations were also found in the suture material for PJ: 65% of cases undergoing double-layer PJ were given monofilament non-absorbable sutures for the outer layer, 35% were given absorbable sutures, and 55% and 41% were given 4/0 and 3/0 sutures, respectively. For inner layer anastomosis, the use of absorbable sutures, monofilament non-absorbable sutures, and 4/0 and 5/0 sutures were 60%, 37%, 45%, and 30%, respectively.…”

Risk analysis of poor wound healing in forceps delivery

“…For the suture methods, it was reported that continuous suture can reduce the levels of pain, analgesia need and achieve better wound healing and shorter repair time, compared to discontinuous suture. 22,23 The wound healing after forceps delivery is affected by a variety of factors. Although the neonatal weight, the condition of amniotic fluid and times of vaginal checks were not included as a risk factor in our multivariate logistic regression analysis, they all showed significant differences in the univariate analysis, respectively, indicating that medical operators should also pay attention to these factors.…”