Continuous non-locking vs. interrupted suturing techniques for the repair of episiotomy or second-degree perineal tears: A single-blind randomized controlled trial

Abstract

ObjectivePerineal trauma is a serious and frequent problem after childbirth which is experienced by millions of women worldwide. The technique used for perineal repair may have an impact on pain and wound healing. The aim of the present study was to compare the continuous non-locking technique with interrupted suturing for the repair of episiotomy or second-degree perineal tears.MethodsA single-blind randomized-controlled trial was conducted from October 2021 to August 2022 in Sina Hospital, Ahvaz, Iran. Three hundred women were selected and randomly assigned into control and intervention groups using block randomization technique. The main outcomes included pain and wound healing that were assessed using visual analog scale (VAS), as well as redness, edema, ecchymosis/bruising, discharge, and approximation scale (REEDA). The secondary outcomes were the use of analgesics, duration of perineal repair, material used for suturing, pain during urination and defecation, and resumption of sexual intercourse. The participants were followed up on the first and seventh days and in the 6th week postpartum. Mann-Whitney, Chi-square, and Generalized Estimating Equations (GEE) model were used for data analysis.ResultsWound healing was significantly better in the continuous non-locking suture technique compared to the interrupted technique (β = −1.98; P > 0.0001). Women also experienced less pain in the continuous non-locking suture technique (β = −2.46; P > 0.0001). There was a reduction in the use of analgesics, the duration of perineal repair, and the material used for suturing in the continuous non-locking suturing technique as opposed to the interrupted method (P < 0.0001).The odds of pain during urination and defecation significantly reduced in women who underwent the continuous non-locking method (P < 0.001). Also, women in the continuous non-locking group resumed their sexual intercourse earlier (P < 0.0001).ConclusionThe findings of this study revealed that use of continuous non-locking technique for suturing was associated with reduced perineal pain and improved wound healing. Furthermore, it was associated with a shorter duration of perineal repair, less suture material used, and less need for analgesics compared with the interrupted method. There is, however, need for more studies to confirm the results of the present study.Iranian registry for randomized controlled trials (Ref. ID: IRCT20190415043283N1).

Continuous Versus Interrupted Sutures for Repair of Episiotomy or Second-Degree Perineal Tears

“…Different studies shows that continuous suture method was less time consuming to performed, required less suture material than the interrupted method and cause less pain than interrupted method. 10 The best technique offers the repair is that which require least time in realization, least consumption of suture material for repair, low pain at short and long period, less necessity to take out the stitches, less frequency of restitching, infection and permitting the sexual intercourse quicker and with less pain. 11 This study is designed to compare the efficacy of different techniques i.e., continuous stitching for repair of perineum versus interrupted stitching.…”

“…Sequel of acquiring study IRB from hospital ethics committee and a written consent from patients to participate voluntarily in this study. Total 300 patients (according to WHO sample size calculator; test value of population and anticipated means was 4.64 & 6.54, respectively with pooled SD was 1.07, level of significance was 5%, and power of test was 80%), 10 of primi and multigravida at term delivered by spontaneous vaginal birth with episiotomy or 2nd degree perineal tear through non probability consecutive sampling were included. Patients ≤ 18 years, had HB% 7.0 g/dl, vaginal breech delivery, 3rd and 4th degree perineal lacerations, delayed wound healing factors i.e., severe anemia, diabetes mellitus, cortical steroids and immune suppressants used patients, and epidural analgesics which affect postpartum pain were excluded.…”