Surgical repair of spontaneous perineal tears that occur during childbirth versus no intervention

Elharmeel, Suzan M. A., Chaudhary, Yasmin, Tan, Stephanie, Scheermeyer, Elly, Hanafy, Ashraf and van Driel, Mieke L. (2011) Surgical repair of spontaneous perineal tears that occur during childbirth versus no intervention. Cochrane Database of Systematic Reviews, 8: CD008534-1-CD008534-22. doi:10.1002/14651858.CD008534.pub2

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Author Elharmeel, Suzan M. A.
Chaudhary, Yasmin
Tan, Stephanie
Scheermeyer, Elly
Hanafy, Ashraf
van Driel, Mieke L.
Title Surgical repair of spontaneous perineal tears that occur during childbirth versus no intervention
Journal name Cochrane Database of Systematic Reviews   Check publisher's open access policy
ISSN 1469-493X
Publication date 2011
Sub-type Article (original research)
DOI 10.1002/14651858.CD008534.pub2
Open Access Status
Issue 8
Start page CD008534-1
End page CD008534-22
Total pages 22
Place of publication Oxford, United Kingdom
Publisher John Wiley & Sons
Collection year 2012
Language eng
Formatted abstract
Background
Perineal tears commonly occur during childbirth. They are sutured most of the time. Surgical repair can be associated with adverse
outcomes, such as pain, discomfort and interference with normal activities during puerperium and possibly breastfeeding. Surgical
repair also has an impact on clinical workload and human and financial resources.

Objectives

To assess the evidence for surgical versus non-surgical management of first- and second-degree perineal tears sustained during childbirth.

Search strategy

We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (1 May 2011), CENTRAL (The Cochrane Library 2011,
Issue 2 of 4) andMEDLINE (Jan 1966 to 2May 2011).We also searched the reference lists of reviews, guidelines and other publications
and contacted authors of identified eligible trials.

Selection criteria

Randomised controlled trials (RCTs) investigating the effect on clinical outcomes of suturing versus non-suturing techniques to repair
first- and second-degree perineal tears sustained during childbirth.

Data collection and analysis

Two review authors independently assessed trials for inclusion and assessed trial quality. Three review authors independently extracted
data.

Main results

We included two RCTs (involving 154 women) with a low risk of bias. It was not possible to pool the available studies. The two studies
do not consistently report outcomes defined in the review. However, no significant differences were observed between the two groups
(surgical versus non-surgical repair) in incidence of pain and wound complications, self-evaluatedmeasures of pain at hospital discharge
and postpartum and re-initiation of sexual activity. Differences in the use of analgesia varied between the studies, being high in the
sutured group in one study. The other trial showed differences in wound closure and poor wound approximation in the non-suturing
group, but noted incidentally also that more women were breastfeeding in this group.

Authors' conclusions

There is limited evidence available from RCTs to guide the choice between surgical or non-surgical repair of first- or second-degree perineal tears sustained during childbirth. Two studies find no difference between the two types of management with regard to clinical outcomes up to eight weeks postpartum. Therefore, at present there is insufficient evidence to suggest that one method is superior to the other with regard to healing and recovery in the early or late postnatal periods. Until further evidence becomes available, clinicians' decisions whether to suture or not can be based on their clinical judgement and the women's preference after informing them about the lack of long-term outcomes and the possible chance of a slower wound healing process, but possible better overall feeling of well being if left un-sutured.

Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Review content assessed as up-to-date: 28 June 2011. Editorial group: Cochrane Pregnancy and Childbirth Group.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2012 Collection
School of Medicine Publications
 
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Created: Wed, 05 Oct 2011, 13:33:37 EST by Elly Scheermeyer on behalf of Paediatrics & Child Health - RBWH