The effect of Xylocaine spray on suture material degradation.

OBJECTIVES: To compare the tensile strength of fast absorbable Polyglactin 910 suture material when impregnated with various agents for local anesthesia and to investigate whether the presence of ethanol in Xylocaine spray could explain a potential reduction in tensile strength after use of Xylocaine spray. METHODS: In all, 120 suture samples of Polyglactin 910 were divided into four groups of 30. These four groups were randomly impregnated with isotonic sodium chloride, isotonic sodium chloride plus Xylocaine spray, isotonic sodium chloride plus Xylocaine gel, or isotonic sodium chloride plus ethanol. After impregnation, the sutures were stored in sealed glass tubes in a heating cabinet at 37°C for 72 h. Thereafter, the tensile strength of these 120 samples was assessed by a universal tensile testing machine. The maximal force needed to break the suture material was recorded in newtons (N). RESULTS: Fast absorbable Polyglactin 910 suture material impregnated with Xylocaine spray or ethanol showed weakened tensile strength (mean values 11.40 and 11.86 N, respectively), whereas the specimens impregnated with Xylocaine gel or sodium chloride retained their tensile strength better (mean values 13.81 and 13.28 N, respectively; mean difference between Xylocaine gel and Xylocaine spray -2.41 N, P < 0.001). CONCLUSION: In this in vitro experiment, ethanol and Xylocaine spray weakened the tensile strength of fast absorbable Polyglactin 910 sutures. Use of Xylocaine spray, which contains ethanol, for local anesthesia might lead to early breakdown of the suture material and wound rupture. The authors suggest caution when using Xylocaine spray in combination with fast absorbable Polyglactin 910 suture.

Early secondary repair of labial tears, 1st and 2nd degree perineal lacerations and mediolateral episiotomies in a midwifery-led clinic. A retrospective evaluation of cases based on photo documentation.

OBJECTIVES: To examine whether early secondary repair of labial tears, 1st and 2nd degree perineal lacerations and episiotomies provided an anatomically acceptable result. STUDY DESIGN: A retrospective analysis of 126 women undergoing an early secondary repair of birth lacerations not involving the sphincter complex within 21 days postpartum. Patients were included from 1 January 2014 to 11 August 2017 at Aarhus University Hospital, Denmark. Photo documentation of the wound was available just before the early secondary repair and at the follow-up visit after the repair. Photos were evaluated by two trained Urogynaecological Consultants. MAIN OUTCOME MEASURES: Whether the anatomic result of the early secondary repair was acceptable based on photo documentation. RESULTS: Early secondary repair was performed by a specialised team of midwives in 94.4% and by doctors in 5.6% of the cases. In all, 72.2% were 2nd degree perineal lacerations. The most common indications for early secondary repair were wound dehiscence (55.3%) and suboptimal primary repair (34.1%). At the follow-up clinical examination seven days after the early secondary repair, the result was considered anatomically acceptable in 67.5% of the cases, not optimal in 22.2% and not possible to evaluate in 10.3% of the cases. In 7.9% of the cases, wound infection was suspected after the early secondary repair. CONCLUSIONS: Based on photo documentation, early secondary repair of birth lacerations not involving the sphincter complex provides an anatomically acceptable result in the majority of cases without risk of serious complications.

An obstetric sphincter injury risk identification system (OSIRIS): is this a clinically useful tool?

INTRODUCTION AND HYPOTHESIS: To establish the contribution of maternal, fetal and intrapartum factors to the risk of incidence of obstetric anal sphincter injuries (OASIS) and assess the feasibility of an OASIS risk prediction model based on variables available to clinicians prior to birth. METHODS: This was a population-based, retrospective cohort study using single-site data from the birth database of Aarhus University Hospital, Denmark. The participants were all women who had a singleton vaginal birth during the period 1989 to 2006. Univariate and multivariate logistic regression analyses were performed using multiple imputations for missing data and internally validated using bootstrap methods. The main outcome measures were the contributions of maternal, fetal and intrapartum events to the incidence of OASIS. RESULTS: A total of 71,469 women met the inclusion criteria, of whom 1,754 (2.45 %) sustained OASIS. In the multivariate analysis of variables known prior to birth, maternal age 20 - 30 years (OR 1.65, 95 % CI 1.44 - 1.89) and ≥30 years (OR 1.60, 95 % CI 1.39 - 1.85), occipitoposterior fetal position (OR 1.34, 95 % CI 1.06 - 1.70), induction/augmentation of labour (OR 1.46, 95 % CI 1.32 - 1.62), and suspected macrosomia (OR 2.20, 95 % CI 1.97 - 2.45) were independent significant predictors of OASIS, with increasing parity conferring a significant protective effect. The 'prebirth variable' model showed a 95 % sensitivity and a 24 % specificity in predicting OASIS with 1 % probability, and a 3 % sensitivity and a 99 % specificity in predicting OASIS with a 10 % probability. CONCLUSIONS: Our model identified several significant OASIS risk factors that are known prior to actual birth. The prognostic model shows potential for ruling out OASIS (high sensitivity with a low risk cut-off value), but is not useful for ruling in the event.

Randomised trial of planned caesarean section prior to versus after 39 weeks: unscheduled deliveries and facility logistics--a secondary analysis.

OBJECTIVES: To compare the impact of scheduling caesarean section prior to versus after 39 completed weeks of gestation on the occurrence of unscheduled caesarean section and rescheduling of the procedure. METHODS: Secondary analysis from a multicentre randomised open-label trial including singleton pregnant women with a healthy foetus and a reliable due date. Women were allocated by computerized telephone randomisation to planned caesarean section at 38 weeks and three days or 39 weeks and three days. The outcomes were unscheduled deliveries with provided reasons, such as spontaneous labour onset or supervening complications, and any changes in the scheduled delivery date. Statistical analyses were according to intention-to-treat using Fisher's exact test. RESULTS: From March 2009 to June 2011 1,274 women were included. Median difference in gestational age at delivery was six days. Compared to the 38 weeks group, the women in the 39 weeks group were more likely to have an unscheduled caesarean section (15.2% vs. 9.3%; RR 1.64, 95% CI 1.21; 2.22), to deliver between 6 pm and 8 am (10 % vs. 6%; RR 1.68, 95% CI 1.14; 2.47), or to have the procedure rescheduled (36.7% vs. 23%; RR 1.6, 95% CI 1.34;1.90). CONCLUSIONS: Scheduling caesarean section after 39 weeks leads to a 60% increase in unscheduled caesarean sections and a 70% increase in delivery outside regular work hours as compared to scheduling of the procedure prior to 39 weeks. TRIAL REGISTRATION: www.clinicaltrials.gov NCT00835003 http://www.clinicaltrials.gov/ct2/show/NCT00835003?term=NCT00835003&rank=1.