Episiotomy repair—immediate and long‐term sequelae. A prospective randomized study of three different methods of repair

Abstract

Three methods of episiotomy repair were randomly assigned after 900 consecutive deliveries. The three procedures were: (1) continuous No. 00-plain catgut in the vagina; No. 00-plain catgut interrupted stiches in the perineal muscles and fascia, and No. 00-nylon interrupted stiches in the skin. (2) The same technique as in (l), but with No. 0-polyglycolic acid (Dexon) in all layers. (3) The suture material as in (2), but used with a subcuticular technique. The women treated with method 3 reported statistically significant less pain and disabilities in the early puerperium. Three months after delivery 262 women (33%) still had perineal complaints which could be directly related to the episiotomy in 25% (8% of total number). The group treated with method 3 had the best long-term results and we conclude that the subcuticular technique using polyglycolic acid should be the method of choice.in all layers, one single needle-mounted suture is sufficient for the entire episiotomy and the suture does not need to 'be removed. This method gave the best results in the early puerperium and also in the long term. This method is now the standard procedure in our department and we regard it as the method of choice for episiotomy repair.

Evaluation of Episiotomy and Spontaneous Tears of Perineum during Childbirth

“…Episiotomy (Ep) is the most common operative procedure during delivery (Pritchard & McDonald 1980, Reading et al 1982, Thacker & Banta 1983. A high frequency of postepisiotomy discomfort and pain has been reported in several studies (Buchan & Nicholls 1980, Kitzinger & Walters 1981Reading et al 1982, Thacker & Banta 1983, Sleep et al 1984, Isager-Sally et al 1986). There are many studies about Ep which document undesirable side effects with almost no evidence that the operation has any benefits.…”

“…The fact that E p had significantly more sutures than ST (Table 111) might have a negative effect on both healing and comfort, due to the long dissolving time of Dexon. According to Willmoth (1980) andIsager et al (1986) Dexon takes three to six weeks to disappear and Buchan & Nicolls (1980) claim that it can take as long as 60-90 days. Even Reading et al (1982) state that a large number of stitches increase the pain.…”

Continuous versus interrupted sutures for repair of episiotomy or second‐degree perineal tears: a randomised controlled trial

“…However, although there is a great preference for one technique, there are only a few clinical trials that compare the effects of different suture techniques on the magnitude of maternal morbidity associated with repair of the perineum. [11][12][13] Fleming 14 published his experience in the use of the subcutaneous suture technique in repairing the skin and suggested that this technique was associated with a lower degree of pain in the perineum compared with other more traditional methods of suture.…”

Dyspareunia following childbirth

“…dyspareunia. Several research studies 1,4,5,[7][8][9][10][11]12 have reported that 62-88% of women resume intercourse by 8-12 weeks postpartum. However, 17-23% continue to experience superficial dyspareunia at three months after delivery and 10-14% at 12 months.…”

“…The effect of suture materials and methods used for repair of episiotomies and perineal tears following delivery has been assessed in several clinical trials with conflicting results relating to reported rates of dyspareunia. 4,7,[10][11]18 Implementation of strategies to reduce assisted vaginal deliveries using the Ventouse vacuum extractor as the instrument of choice rather than forceps, reducing episiotomy rate and improving perineal repair techniques, will probably help in decreasing the extent of postpartum sexual morbidity experienced by women.…”