A randomised trial, conducted by midwives, of perineal repairs comparing a polyglycolic suture material and chromic catgut.

OBJECTIVE

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.

DESIGN

randomised controlled trial.

SETTING

tertiary obstetric hospital in Australia.

PARTICIPANTS

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.

INTERVENTION: eligible women were randomly allocated for repair with either polyglycolic acid or chromic catgut.

MAIN OUTCOME MEASURES: perineal pain and dyspareunia up to six months postpartum.

FINDINGS: 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).

CONCLUSIONS

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.