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Absorbable stitches

for repair of
episiotomy and tears
at childbirth

Background

Approximately 70% of women will experience perineal


trauma following vaginal delivery and will require
stitches.

This may result in pain, suture removal and superficial


dyspareunia.

Objectives
To

assess the effects of different suture


materials on short- and long-term
morbidity following perineal repair.

Search methods
Cochrane

Pregnancy and Childbirth


Groups Trials Register were
searched(February 2010).

Selection criteria
Randomised

trials comparing different


suture materials for perineal repair after
vaginal delivery.

Data collection and analysis


Two

review authors independently


assessed trial quality and extracted data.

Main results

18 trials with 10,171 women was included;

comparisons included:

catgut with standard synthetic (11 trials),

rapidly absorbing synthetic versus standard synthetic sutures


(5 trials)

Standard catgut versus glycerol impregnated catgut(two


trials);

Absorbable monofilament sutures versus standard


polyglycolic

Absorbable synthetic sutures versus catgut: 11 trials


with 5072 women

In trials comparing standard absorbable synthetic sutures with catgut,


fewer women with synthetic sutures experienced pain.

In those trials examining analgesia use up to 10 days, women with synthetic


sutures had less analgesia than those with catgut sutures

More women with catgut sutures required resuturing (15/1201) compared


with synthetic sutures3/1201))

while more women with standard synthetic sutures required the removal of
unabsorbed suture material

Fast absorbing versus standard synthetic sutures: five


trials with 2349 women

There was no significant evidence of any difference between groups sutured with standard versus
rapidly absorbing sutures in the numbers of women experiencing perineal pain at321 up to three days
after delivery

Similarly, differences between groups for perineal pain at 10 to 14 days were not statistically significant

Use of analgesia for perineal pain was reported in one trial, and fewer women with rapidly absorbing
sutures were using analgesics at 10 days post delivery

Women sutured with fast-absorbing synthetic sutures were more likely to have wound skin edges gaping
at up to 10 days,compared with those with standard synthetic sutures

Three women sutured with fast-absorbing material required resuturing compared with one woman with
standard synthetic sutures

More women with standard sutures required the removal of suture material compared with those with
rapidly absorbing stitches

Standard catgut versus glycerol impregnated catgut:


two trials with 1737 women

Pain at three days after delivery was examined in one trial and there was no evidence of
any difference between groups sutured with either chromic catgut or glycerol impregnated
catgut (Softgut)

At 10 to 14 days pain was measured in two trials and Softgut was associated with more
women experiencing pain,

There was no significant difference in the number of women with wound dehiscence at 10
days

More women with standard catgut required the removal of suture material by three months

Approximately 25%of women continued to experience dyspareunia three months after the
birth of their babies.

Absorbable monofilament sutures versus standard


polyglycolic: one trial with 1139 women

Only one trial contributed data to this outcome .

There was no evidence of any differences in mean pain scores for women
repaired with synthetic monofilament sutures or polyglycolic acid sutures
at one to three days after delivery.

There was no strong evidence of any difference between group for pain at
eight to 12 weeks .

Women sutured with monofilament material were more likely to report


wound problems at eight to 12 weeks .

One woman in each group had wound breakdown requiring resuturing.

As

well as the type of material used, other

factors such as the technique used to carry out


the stitching (using a continuous thread or a
series of separately tied stitches) and the
skill of the person carrying out the procedure,
may also affect the amount of pain and the
way perineal wounds heal.

THANK YOU