85% of women who have a spontaneous vaginal birth will have some form of damage to the perineum, and up to 69% will need to have sutures (stitches). Annually, around 350,000 women in the UK—and millions of women worldwide—require sutures after vaginal delivery
Christine Kettle and colleagues from North Staffordshire Hospital (NHS Trust), Stoke on Trent, UK, compared two different suturing techniques (continuous and interrupted), and two types of suture (the more rapidly absorbed polyglactin 910 suture material and the standard polyglactin 910 material). With continuous suturing, the perineal muscle and skin are re-approximated with a loose, continuous non-locking technique; the skin sutures are placed loosely and fairly deep in the subcutaneous tissue and the repair is finished with a loop knot inserted in the vagina. In the interrupted method, the vaginal trauma is re-approximated with a continuous locking (blanket) stitch, with interrupted sutures inserted to re-align the perineal muscles and interrupted transcutaneous stitches inserted to close the skin edges of the wound.
1542 women who had a spontaneous vaginal delivery with associated damage to the perineum were randomly allocated to either the continuous or interrupted suturing method, and to receive either the more rapidly absorbed or standard suture material. Substantially fewer women (26.5%) reported pain at 10 days with the continuous technique than with the interrupted method (44%). Suture removal was less frequent with the more rapidly absorbed material (in 3% of women) than with standard suture material (13%); similarly, women given continuous suturing required substantially less suture removal within three months than women given the interrupted method (3% compared with 12.5%).
Christine Kettle comments: "We provide evidence that the continuous suturing technique should be used for perineal repair. The introduction of a continuous suturing policy would reduce overall expenditure, since less suturing material is needed than for the interrupted method of repair. Use of the more rapidly absorbed polyglactin 910 material is associated with a substantial reduction in the need to have sutures removed. These findings are of importance to women and professionals wherever childbirth takes place. There is an urgent need to make appropriate perineal-repair training programmes available for midwives and doctors."
Contact: Mrs Christine Kettle, North Staffordshire Hospital (NHS Trust), Women and Children's Directorate, City General Site, Newcastle Road, Stoke on Trent ST4 6QG, UK; T) +44 (0)1782 552484; F) +44 (0)1782 710936; E) chris@kogs.freeserve.co.uk
Journal
The Lancet