Continuous stitching method reduces pain for women with perineal damage after childbirth

Authors of a study in this week's issue of THE LANCET suggest that a simple, continuous stitching technique to repair tears to the perineum after vaginal delivery can prevent one woman in six from having pain ten days after childbirth. The study also highlights how the use of more rapidly absorbed suture material can avoid the need for the removal of stitches up to 3 months after delivery for one in ten women.

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 UKand millions of women worldwiderequire 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) t

Contact: Richard Lane

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