OBJECTIVE: To examine differences in outcome between primiparous women who do and who do not have suturing to first or second degree perineal lacerations sustained during spontaneous vaginal births after 37 weeks of gestation. DESIGN: Parallel group randomised controlled trial. SETTING: Bellshill Maternity Hospital, Lanarkshire, and St John's Hospital, Livingston. POPULATION: Primigravidae with perineal lacerations following spontaneous birth. METHODS:One thousand and three hundred fourteen women were recruited to the trial antenatally from whom 74 were randomised either to be sutured or not sutured immediately after giving birth. Randomisation was stratified by degree of tear. MAIN OUTCOME MEASURES: Using standardised measures, perineal pain and healing were measured at 1 and 10 days and 6 weeks postpartum. In addition, postnatal depression was assessed at 10 days and 6 weeks postpartum. RESULTS: Findings indicated that there were no significant differences between the groups with regard to pain or depression but there were differences with regard to healing. At six weeks, there remained a significant difference in wound closure between the groups, with women who had not been sutured having poorer wound approximation. CONCLUSIONS: While acknowledging the small sample size, the results are nonetheless important, showing persistent evidence of poorer wound approximation in those women who had not been sutured. Practitioners need to review the present practices of not suturing perineal lacerations until research examining the longer term implications is undertaken.
RCT Entities:
OBJECTIVE: To examine differences in outcome between primiparous women who do and who do not have suturing to first or second degree perineal lacerations sustained during spontaneous vaginal births after 37 weeks of gestation. DESIGN: Parallel group randomised controlled trial. SETTING: Bellshill Maternity Hospital, Lanarkshire, and St John's Hospital, Livingston. POPULATION: Primigravidae with perineal lacerations following spontaneous birth. METHODS: One thousand and three hundred fourteen women were recruited to the trial antenatally from whom 74 were randomised either to be sutured or not sutured immediately after giving birth. Randomisation was stratified by degree of tear. MAIN OUTCOME MEASURES: Using standardised measures, perineal pain and healing were measured at 1 and 10 days and 6 weeks postpartum. In addition, postnatal depression was assessed at 10 days and 6 weeks postpartum. RESULTS: Findings indicated that there were no significant differences between the groups with regard to pain or depression but there were differences with regard to healing. At six weeks, there remained a significant difference in wound closure between the groups, with women who had not been sutured having poorer wound approximation. CONCLUSIONS: While acknowledging the small sample size, the results are nonetheless important, showing persistent evidence of poorer wound approximation in those women who had not been sutured. Practitioners need to review the present practices of not suturing perineal lacerations until research examining the longer term implications is undertaken.
Authors: Debra E Bick; Khaled M Ismail; Sue Macdonald; Peter Thomas; Sue Tohill; Christine Kettle Journal: BMC Pregnancy Childbirth Date: 2012-06-25 Impact factor: 3.007