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Objective To investigate the relation between the use of mediolateral episiotomy and the Design An observational study. Subjects Data were derived from the Dutch National Obstetric Database (LVR) of 1990, from which 43 309 spontaneous, occipito-anterior, vaginal deliveries of live, singleton infants were investigated.occurrence of severe (third degree) perineal tears in hospital deliveries in the Netherlands.Intervention Medio-lateral episiotomy.Main outcome measure The occurrence of severe perineal tears.197 1 -1975. 587-590.

Three different sliding knots were tested using five recently developed monofilament and multifilament suture materials. The resorbable materials were polyglactin-910 (Vicryl), polyglycolic-acid (Dexon-Plus), polyglyconate (Maxon), and polydioxanone (PDS), and the nonresorbable material was polypropylene (Prolene). For each type of sliding knot, three or five throws of suture were tested. Knot strength was determined by the loop holding capacity, which was defined as the strength at which the knot broke, or at which slippage in the knot amounted to more than 2 mm. When the three kinds of sliding knots were compared, identical sliding knots with identical throws around a single suture were found to be the most unreliable. Nonidentical and parallel sliding knots differed little with respect to knot reliability. Five-throw knots were generally stronger than three-throw knots. However, the effect of adding two extra throws to three-throw sliding knots was only significant if monofilament suture material was used. Comparison of the different suture materials revealed major differences in knot holding ability. These findings indicate that knot strength is dependent on both the type of knot and the type of suture material, and surgeons should be cognizant of these variables.

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The suture's knot site represents the highest amount and density of foreign body material of a knotted suture loop. The volume of a knot is directly related to the total amount of inflammatory reaction surrounding the knot. We measured the volume of seven surgical knots frequently used in surgical practice. Two different suture materials and two different sizes were tested. Suture size was found to contribute significantly more to the volume of all knots tested than the number of throws of which the knots were composed. Knots made with coated multifilament polyglactin-910 were significantly larger than the knots made with monofilament nylon. Clinical implications of these findings are discussed. Surgical techniques keeping the volume of knots to a possible minimum, are encouraged.