A randomised trial, conducted by midwives, of perineal repairs comparing a polyglycolic suture material and chromic catgut. The Southmead perineal suture study. A randomized comparison of suture materials and suturing techniques for repair of perineal trauma. Impact of chromic catgut versus polyglactin 910 versus fast-absorbing polyglactin 910 sutures for perineal repair: a randomized, controlled trial. The Ipswich Childbirth Study: 2. A randomised comparison of polyglactin 910 with chromic catgut for postpartum perineal repair. Episiotomy repair--immediate and long-term sequelae. A prospective randomized study of three different methods of repair. [Repair of episiotomies with synthetic suture material]. Randomized comparison of chromic versus fast-absorbing polyglactin 910 for postpartum perineal repair. [A comparison between chromic catgut and polyglycolic acid sutures in episiotomy repair (author's transl)]. Continuous versus interrupted perineal repair with standard or rapidly absorbed sutures after spontaneous vaginal birth: a randomised controlled trial.
to assess the effect of suture materials (an absorbable synthetic suture material versus catgut) used in perineal repairs undertaken by midwives who had been trained and accredited in repair techniques.
                randomised controlled trial.
                tertiary obstetric hospital in Australia.
                391 women with a live singleton birth at > or =34 weeks gestation, resulting from a spontaneous vaginal delivery and who required perineal repair due to either an episiotomy or first or second degree tear.
                eligible women were randomly allocated for repair with either polyglycolic acid or chromic catgut.
                perineal pain and dyspareunia up to six months postpartum.
                of the 194 women allocated to polyglycolic suture 106 (55%) were primipara compared with 79 (40%) of the 197 women allocated to catgut. Due to this unexplained imbalance, odds ratios were estimated with and without adjustment for parity. The parity-adjusted odds ratios were little changed (<11%) from the crude odds ratios. Although there were no statistically significant differences, parity-adjusted odds ratios (aOR) suggest that compared with women sutured with catgut, women sutured with polyglycolic were less likely to experience perineal pain at Day 3 postpartum (aOR=0.70 95% confidence interval [95% CI] 0.46-1.08) but by six months postpartum were somewhat more likely to experience perineal pain (aOR=1.77, 95% CI 0.57-5.47), dyspareunia (aOR=1.21 [0.62-2.33] and require removal of a suture (aOR=2.61 95% CI 0.59-12.41).
                the finding of reduced short-term perineal pain in women repaired with polyglycolic compared with catgut is similar to that of a Cochrane Systematic Review. The possibility that polyglycolic is associated with worse longer-term outcomes has not been previously reported but is biologically plausible (catgut causes a local inflammatory reaction but is rapidly absorbed, while polyglycolic causes little inflammation but absorption takes longer). This trial also illustrates the difficulties of undertaking clinical research in a busy delivery ward. Commonly used suture materials and techniques for perineal repair following vaginal delivery were compared in a randomized controlled trial involving 1574 women. Three comparisons were made using a modified factorial design. In the comparison of teflon-coated polyglycolic acid (Dexon plus) with chromic catgut for repair of the vagina and deep perineal tissues there was no clear difference other than less short-term analgesia being required in association with polyglycolic acid. Outcome was also similar after skin repair with either polyglycolic acid or chromic catgut or silk, although silk repair required more packets of material and was associated with delay in resuming sexual intercourse; polyglycolic acid was more likely to need removal than chromic catgut but it appeared to reduce the need for resuturing. There was no clear difference between continuous subcuticular and interrupted transcutaneous sutures for repair of perineal skin. The goal of our study was to compare the impact of 3 suture materials on perineal pain and on resumption of sexual intercourse.
                This randomized, controlled trial compared 3 types of suture materials (chromic catgut, polyglactin 910, fast-absorbing polyglactin 910) for second-degree perineal laceration or uncomplicated episiotomy. Patients were enrolled in early labor and assigned randomly to 1 of the 3 suture materials. Pain was evaluated at 48 hours, 6 weeks, and 3 months. The study subjects were questioned about residual perineal pain, resumption of sexual activity, and pain-free sexual intercourse. Logistic regression analyses were undertaken.
                Of the 192 patients who were assigned randomly to groups, 66 patients had their perineal laceration repaired with chromic catgut; 60 patients had repair with polyglactin 910, and 66 patients had repair with fast-absorbing polyglactin 910. At 48 hours, there was no significant difference according to the pain measurement scores, but the median consumption of analgesics was significantly lower with fast-absorbing polyglactin 910 than with standard polyglactin 910. There was no difference in the resumption of sexual intercourse at 6 weeks after the delivery between chromic catgut (42%) compared with standard polyglactin 910 group (56%; P = .23). However, it was more frequent for women in the fast-absorbing polyglactin 910 group (66%; P = .02). After adjustment for confounding variables, perineal repair with fast-absorbing polyglactin 910 was associated with a higher rate of sexual intercourse (odds ratio, 2.55; 95% CI, 1.07-6.10) and a higher rate of pain-free sexual intercourse (odds ratio, 2.51; 95% CI, 1.03-6.10) at 6 weeks after delivery.
                Fast-absorbing polyglactin 910 for perineal repair is associated with earlier resumption of sexual intercourse when compared with chromic catgut. To compare polyglactin 910 sutures with chromic catgut sutures for postpartum perineal repair.
                A stratified randomised controlled trial, using a 2 x 2 factorial design.
                The maternity unit at Ipswich Hospital NHS Trust, a district general hospital, between 1992 and 1994.
                1780 women who had sustained an episiotomy or first or second degree tear following a spontaneous or simple instrumental delivery.
                Policies of repair with polyglactin 910 or chromic catgut were compared. Both groups were assessed by a research midwife completing questionnaires at 24 to 48 hours and at ten days postpartum, and by self-completed questionnaires at three months after birth.
                1. 24 to 48 hours postpartum: perineal pain, healing; 2. ten days postpartum: perineal pain, healing and removal of sutures; 3. three months postpartum: perineal pain, removal of sutures, resuturing, dyspareunia, and failure to resume pain-free intercourse.
                Completed questionnaires were returned for 99% of women at both 24 to 48 hours and ten days and by 93% of women three months postpartum. The two groups were similar at trial entry. Significantly fewer women allocated to the polyglactin 910 reported pain in the previous 24 hours at both 24 to 48 hours (59% vs 67%; RR 0.89, 95% CI 0.83-0.95; 2P < 0.01), and ten days (24% vs 29%; RR 0.81, 95% CI 0.69-0.95; 2P = 0.01). At three months postpartum there was no clear difference between the groups in terms of perineal pain, dyspareunia or failure to resume pain-free intercourse. More women in the polyglactin 910 group reported that some suture material had been removed (12% vs 7%; RR 1.62, 95% CI 1.19-2.21; 2P < 0.01). Three women in the polyglactin 910 group had required resuturing compared with ten in the chromic catgut group (RR 0.30; 95% CI 0.08-1.09; 2P = 0.1).
                Using polyglactin 910 rather than chromic catgut for perineal repair leads to about one fewer women among every 20 having perineal pain and using analgesia ten days postpartum. Its only apparent disadvantage is that more women, again estimated as 1 in 20, report having material removed during healing. Data from this and other trials suggest that for every 100 women repaired with a polyglycolic acid-based material, about one fewer will require resuturing. Three methods of episiotomy repair were randomly assigned after 900 consecutive deliveries. The three procedures were: (1) continuous No. 00-plain catgut in the vagina; No. 00-plain catgut interrupted stitches in the perineal muscles and fascia, and No. 00-nylon interrupted stitches in the skin. (2) The same technique as in (1), but with No. 0-polyglycolic acid (Dexon) in all layers. (3) The suture material as in (2), but used with a subcuticular technique. The women treated with method 3 reported statistically significant less pain and disabilities in the early puerperium. Three months after delivery 262 women (33%) still had perineal complaints which could be directly related to the episiotomy in 25% (8% of total number). The group treated with method 3 had the best long-term results and we conclude that the subcuticular technique using polyglycolic acid should be the method of choice. The aim of the current study is to investigate possibilities for episiorrhaphy with synthetic sutures and patients follow up for complains and physical status.
                The present study is prospective and it includes 180 patients. We used for episiorrhaphy: synthetic sutures Polyglycolic acid (1st group), Polyglactin 910 (2nd group) and plain cat gut and silk (3rd group). Vaginal walls, perineum and skin, in the former two groups of patients, had been sutured only with synthetic suture materials. In the third group we used plain cat gut for vaginal walls and perineum sutures and silk sutures for the skin. We used classical surgical and anesthesiological technics. We followed up anatomical repair, presence ofperineal pain, doctors opinion and patients' attitude. We took into account 5th day post partum results.
                Anatomical repair of the episiorrhaphy doesn't differ significantly depending on the type of suture material (n.s.-P>0.05). All episiorrhaphies had been healed primary. In the groups were Polyglycolic acid or Polyglactin 910 had been used, local injury reaction (erythema, edema) had been developed more slightly compared with plain cat gut - silk group. Functional results as perineal pain are significantly less expressed in Polyglycolic acid and Polyglactin 910 groups. These patients had pain less frequently and with lesser degree (s.-P<0.05). In these groups patients didn't suffer from fear of sutures removal and sutures were both functional and cosmetic. We conducted a randomized trial to evaluate the healing characteristics of chromic versus fast-absorbing polyglactin 910.
                Laboring women were randomly assigned to chromic or fast-absorbing polyglactin for perineal repairs. Subjects were evaluated at 24-48 hours, 10-14 days, and 6-8 weeks to assess perineal and uterine pain, analgesic use, presence of residual suture, and wound dehiscence.
                Between April 2002 and January 2003, 1,361 subjects were randomly assigned. Two thirds of women in each group (459 fast-absorbing polyglactin and 449 chromic) required sutures for perineal repairs. Women were evaluated according to randomization assignment. Overall, 794 (87%) of subjects received the appropriate allocated suture to repair a perineal laceration (399 of 459, 86.9% fast-absorbing polyglactin 910; 395 of 449, 88% chromic catgut). At 24-48 hours, there was a statistically significant reduction in uterine cramping pain (25% versus 34%; P =.006) in subjects randomly assigned to fast-absorbing polyglactin. At 10-14 days, there were no statistically significant differences between the groups. At 6-8 weeks there was, again, a statistically significant reduction in uterine cramping pain (1% versus 4%; P =.017) and a statistically significant decrease in analgesic use (5% versus 10%; P =.048) in subjects randomly assigned to fast-absorbing polyglactin. Finally, at 6-8 weeks postpartum there was no difference in residual suture (2 of 175 versus 2 of 134; P =.802) or wound breakdowns (4 of 175 versus 3 of 134; P =.959) for fast-absorbing polyglactin 910 and chromic catgut, respectively.
                Our data suggest that fast-absorbing polyglactin 910 and chromic elicit similar postpartum perineal discomfort. In contrast to previous studies evaluating standard polyglactin, our trial demonstrated that fast-absorbing polyglactin rarely requires late removal and has a similar wound breakdown profile as compared with chromic.
                I Polyglycolic acid sutures (Dexon) were compared to chromic catgut sutures in episiotomy repair. When polyglycolic acid sutures were used, the degree of postpartum perineal pain was approximately half as great, and the incidence of dehiscence of episiotomy was 3--5 times greater in the chromic catgut group. The cosmetic results 3 months postpartum were clearly better by using Dexon sutures, especially when the perineal skin was closed by a continuous intracutaneous suture. Trauma to the perineum is a serious and frequent problem after childbirth, with about 350000 women each year in the UK needing sutures for perineal injury after spontaneous vaginal delivery, and many millions more worldwide. We compared the continuous technique of perineal repair with the interrupted method, and the more rapidly absorbed polyglactin 910 suture material with the standard polyglactin 910 material.
                1542 women who had a spontaneous vaginal delivery with a second-degree perineal tear or episiotomy were randomly allocated to either the continuous (n=771) or interrupted (771) suturing method, and to either the more rapidly absorbed polyglactin 910 suture material (772) or standard polyglactin 910 material (770). Primary outcomes were pain 10 days after delivery and superficial dyspareunia 3 months postpartum. Analysis was by intention to treat.
                At day 10, three women had dropped out of the study. Significantly fewer women reported pain at 10 days with the continuous technique than with the interrupted method (204/770 [26.5%] vs 338/769 [44.0%], odds ratio 0.47, 95% CI 0.38-0.58, p<0.0001). Occurrence of pain did not differ significantly between groups assigned the more rapidly absorbed material or standard material (256/769 [33.3%] vs 286/770 [37.1%], 0.84, 0.68-1.04, p=0.10). Women reported no difference in superficial dyspareunia at 3 months for the continuous vs the interrupted method (98/581 [16.9%] vs 102/593 [17.2%], 0.98, 0.72-1.33, p=0.88) or the more rapidly absorbed versus standard material (105/586 [17.9%] vs 95/588 [16.2%], 1.13, 0.84-1.54, p=0.42). Suture removal was done less with the more rapidly absorbed material than with standard suture material (22/769 [3%] vs 98/770 [13%], p<0.0001), and with the continuous versus interrupted method (24/770 [3%] vs 96/769 [12%], p<0.0001).
                A simple and widely practicable continuous repair technique can prevent one woman in six from having pain at 10 days. Also, the more rapidly absorbed polyglactin 910 material obviates need for suture removal up to 3 months postpartum for one in ten women sutured.
Catgut may increase short-term pain compared with synthetic sutures. There were few differences between standard and rapidly absorbing synthetic sutures but more women needed standard sutures removing. For other materials, there was insufficient evidence to draw conclusions. Findings should be interpreted in the context of the related Cochrane review on suturing techniques.