Does perineal suturing make a difference? The SUNS trial

Fleming, Valerie; Hagen, Suzanne; Niven, Catherine A.

doi:10.1046/j.1471-0528.2003.02353.x

Cited by 49 publications

(43 citation statements)

References 21 publications

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“…These findings suggest that experiencing any degree of perineal trauma is associated with a higher risk of experiencing depressive symptoms and that symptoms can be persistent for those with a 2nd degree or more severe tear. In contrast, the second study found no effect of sutured vs. unsutured 2nd degree tears on EPDS scores at 10 days and 6 weeks postpartum (Fleming et al., ). The differences in findings between the two studies may be due to differences in discomfort and healing.…”

Section: Resultsmentioning

confidence: 96%

A systematic mixed studies review of women's experiences of perineal trauma sustained during childbirth

Crookall

Fowler

Wood

et al. 2018

Journal of Advanced Nursing

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Section: Resultsmentioning

confidence: 96%

A systematic mixed studies review of women's experiences of perineal trauma sustained during childbirth

Crookall

Fowler

Wood

et al. 2018

Journal of Advanced Nursing

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“…Non-suturing of second degree tears has persisted in UK midwifery practice, despite current recommendations for practice, based on a systematic review of the evidence, supporting suturing [4]. Two small randomised controlled trials compared suturing versus non-suturing of second-degree tears [19,20] although both lacked statistical power. Lundquist et al [19] randomised 80 primiparous women to be sutured or not sutured, collecting data on pain, discomfort and dyspareunia at 2 to 3 days, 8 days and 6 months after birth.…”

Section: Discussionmentioning

confidence: 99%

“…Results showed ‘small’ lacerations left unsutured healed as well as ones which were sutured, however the definition and measurement of healing was not clarified, nor was a definition of a ‘small’ laceration provided. Fleming et al [20] randomised 74 primparous women who sustained a first or second degree tear to be sutured (n = 33) or not sutured (n = 41). Perineal pain and wound healing were assessed at 1 and 10 days and six weeks postpartum, and postnatal depression assessed at 10 days and six weeks postpartum.…”

Section: Discussionmentioning

confidence: 99%

How good are we at implementing evidence to support the management of birth related perineal trauma? A UK wide survey of midwifery practice

Bick

Ismail

Macdonald

et al. 2012

BMC Pregnancy Childbirth

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BackgroundThe accurate assessment and appropriate repair of birth related perineal trauma require high levels of skill and competency, with evidence based guideline recommendations available to inform UK midwifery practice. Implementation of guideline recommendations could reduce maternal morbidity associated with perineal trauma, which is commonly reported and persistent, with potential to deter women from a future vaginal birth. Despite evidence, limited attention is paid to this important aspect of midwifery practice. We wished to identify how midwives in the UK assessed and repaired perineal trauma and the extent to which practice reflected evidence based guidance. Findings would be used to inform the content of a large intervention study.MethodsA descriptive cross sectional study was completed. One thousand randomly selected midwives were accessed via the Royal College of Midwives (RCM) and sent a questionnaire. Study inclusion criteria included that the midwives were in clinical practice and undertook perineal assessment and management within their current role. Quantitative and qualitative data were collated. Associations between midwife characteristics and implementation of evidence based recommendations for perineal assessment and management were examined using chi-square tests of association.Results405 midwives (40.5%) returned a questionnaire, 338 (83.5%) of whom met inclusion criteria. The majority worked in a consultant led unit (235, 69.5%) and over a third had been qualified for 20 years or longer (129, 38.2%). Compliance with evidence was poor. Few (6%) midwives used evidence based suturing methods to repair all layers of perineal trauma and only 58 (17.3%) performed rectal examination as part of routine perineal trauma assessment. Over half (192, 58.0%) did not suture all second degree tears. Feeling confident to assess perineal trauma all of the time was only reported by 116 (34.3%) midwives, with even fewer (73, 21.6%) feeling confident to perform perineal repair all of the time. Two thirds of midwives (63.5%) felt confident to perform an episiotomy. Midwives qualified for 20 years or longer and those on more senior clinical grades were most likely to implement evidence based recommendations and feel confident about perineal management.ConclusionsThere are considerable gaps with implementation of evidence to support management of perineal trauma.

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“…Four studies were found that had examined differences in outcomes in women who had perineal lacerations sutured or not sutured 14–17 . Studies have shown disparities in findings with regard to healing of sutured and nonsutured trauma 14,17 .…”

Section: Introductionmentioning

confidence: 99%

Clinical Decision‐Making for Repair of Spontaneous Childbirth Trauma: Validation of Cues and Related Factors

Cioffi

Arundell

Swain

2009

J Midwife Womens Health

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From recalled childbirth cases, a series of cues and related factors were previously identified that were used by midwives when making decisions to suture or not suture perineal and associated trauma incurred during spontaneous vaginal delivery. This study aimed to determine the validity of these cues and related factors. A panel of 18 experienced midwives evaluated their content validity using the criteria of "necessity" and "sufficiency." The two main cue categories-"bleeding" and "birth trauma"-were considered by 18 (100%) of the panel members to be necessary to assess. At least 16 (89%) panel members considered the following specific cues necessary to assess: in the bleeding category-type, flow, amount, and effect of application of pressure or ice; in the birth trauma category-trauma sites, trauma types, dimensions of trauma, types of tissue, alignment of tissue, edema, and bruising. Seventeen (94%) panel members considered seven woman-centred related factors that were necessary to assess and 14 (78%) considered the combination of all cues in bleeding, birth trauma, and related factors sufficient for making the decision to suture or not. The availability of these validated cues and related factors has the potential to guide a comprehensive assessment on which the decision to suture or not suture depends. This addition to the domain of midwifery knowledge enables educational preparation of midwives who will have the capacity to more adequately support women in childbirth.

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Does perineal suturing make a difference? The SUNS trial

Cited by 49 publications

References 21 publications

A systematic mixed studies review of women's experiences of perineal trauma sustained during childbirth

A systematic mixed studies review of women's experiences of perineal trauma sustained during childbirth

How good are we at implementing evidence to support the management of birth related perineal trauma? A UK wide survey of midwifery practice

Clinical Decision‐Making for Repair of Spontaneous Childbirth Trauma: Validation of Cues and Related Factors

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