Continuous versus discontinuous suture in perineal injuries produced during delivery in primiparous women: a randomized controlled trial.

BACKGROUND: The technique used in the repair of a perineal injury resulting from childbirth could avoid discomfort and morbidity during the postpartum period. Recent studies show inconsistent results and support the need for new research with the inclusion of new health parameters not yet studied. Therefore, this study aims to evaluate if the suture technique (continuous or interrupted) has an effect on pain and other postpartum problems, incidence of incontinence (urinary and/or fecal), and the restart of sexual relations. METHODS: A single-blind randomized clinical trial was conducted in five hospitals in south-east Spain. The participants were primiparous women who had experienced a perineal injury during delivery (second-degree tear or episiotomy). Data was collected on sociodemographic variables, variables associated with pregnancy, labor and delivery, and the postpartum period, and outcomes during the 3 months after delivery: pain, incontinence, and restart of sexual relations. Odds ratios (OR) were calculated by binary logistic regression to assess the influence of the suture type on binary outcomes and t-test used for comparing continuous outcomes. Multivariate analyses (using logistic regression -adjusted (aOR)- and analysis of covariance) were carried out to adjust for unbalanced variables after randomization. RESULTS: A total of 70 women were included in the intervention group (continuous suture) and 64 in the reference group (interrupted sutures). A negative association was observed (aOR = 0.39; 95% CI = 0.18-0.86) between a continuous suture and the need for analgesia at 24 h postpartum. Pain experienced by the women at 24 h postpartum was assessed as 4.4 ± 0.3 compared with a score of 3.4 ± 0.3 in the group with continuous sutures (p = 0.011). At 15 days postpartum, women in the intervention group experienced less pain (aOR = 0.38; 95% CI = 0.18-0.80) (p = 0.019). Urinary sphincter incontinence was also evaluated at 15 days, with 4.3% (n = 3) of the women in the intervention group presenting with urinary incontinence compared with 18.8% (n = 12) in the control group (aOR = 0.11; 95% CI = 0.03-0.47) (P = 0.003). CONCLUSIONS: The women who had a continuous suture repair showed lower levels of pain from delivery to 3 months after delivery and had a lower incidence of urinary incontinence at 15 days postpartum. TRIAL REGISTRATION: ClinicalTrials.gov NCT03825211 posted January 31, 2019 (retrospectively registered).

Suture type used for perineal injury repair and sexual function: a randomised controlled trial.

The type of suture used to repair perineal injury may be associated with this healing process and subsequent sexual function. This study aims to assess whether the suture technique used (continuous or interrupted) has an impact on a woman's sexual function following childbirth. A single-blind randomised clinical trial was conducted with primiparous women who had experienced a perineal injury during childbirth. A computer-generated random number table was applied to allocate women to each group. Data were collected on sociodemographic variables, variables associated with childbirth, and outcomes during the 3 months after childbirth. Mean difference was used to assess the influence of the suture type on outcomes. Multivariate analyses were carried out to adjust for unbalanced variables after randomisation. Seventy women participated in the intervention group (continuous suture) and 64 women in the control group (interrupted suture). The women in the intervention group scored high for sexual desire, adjusted mean difference (aMD) = 1.8, 95% CI = 1.1-2.6 (p < 0.001); the same happened with arousal (aMD = 1.7, 95% CI = 0.8-2.5, p < 0.001). In the intervention group, orgasm was more easily reached, aMD = 0.8, 95% CI = 0.4-1.1 (p < 0.001). Women who received a continuous suture indicated they felt less discomfort (p < 0.001). Women who had a continuous suture reported better postpartum sexual function.Trial registration: ClinicalTrials.gov NCT03825211 posted 31/01/ 2019.

Maternal Age and Pregnancy, Childbirth and the Puerperium: Obstetric Results.

Delaying maternity is becoming more common, resulting in questions regarding the influence age may have on obstetric results. Therefore, we proposed the objective to determine the association between maternal age and different health variables during pregnancy, childbirth and the puerperium. We conducted an observational study in Spain with primiparous women in which data was collected on sociodemographic, health and obstetric variables. Crude and adjusted mean differences were calculated with their corresponding 95% confidence intervals. The study included a final sample of 373 women. The mean age of women presenting with hypertension during pregnancy was 34.54 years (95% CI: 31.80-37.27) compared with a mean of 30.11 (95% CI: 29.56-30.66) in women that did not (p = 0.002). Women who had a eutocic delivery were also younger: 29.17 years (95% CI: 28.48-29.86) compared with 31.90 years (95% CI: 31.05-32.74; p < 0.001) for those that had a dystocic delivery. The duration of dilatation was longer in those ≥35 years (p = 0.001). In conclusion, an advanced maternal age is associated with a higher incidence of pathology during pregnancy and dystocic labor.